Perforated caecal diverticulum as a content of inguinal hernia — report of a rare case

Abstract

A tablet induced perforation of a caecal diverticulum into a hernial sac is a rare happening. The report discusses the presentation and outcome of a patient with such an unusual disease. A 55-year-old man presented with features of irreducible right sided indirect inguinal hernia. A hard swelling near upper pole of right testis was noted. Scrotal ultrasound revealed a normal testis. At operation caecum and proximal ascending colon were found in the hernial sac with the caecum adherent to the testis. As caecal malignancy could not be ruled out and enbloc Rt Haemicolectomy with Rt orchidectomy was performed. The patient had an uneventful recovery. Pathological examination of the specimen revealed a perforated caecal diverticulum with presence of multiple tablets in its lumen invaginating the upper pole of right testis without any evidence of malignancy. Tablet induced perforation of a caecal diverticulum into a hernial sac is a rare clinical entity. If malignancy cannot be negated at operation, a right haemicolectomy is a safe and feasible option.

Management of inflamed sigmoid diverticulum inside an incarcerated right inguinal hernia: Case report of a rare discovery

“…It is very rare for a colonic diverticulum to herniate into an inguinal hernia. There are a few cases reporting perforated diverticulitis or a diverticular abscess presenting as an incarcerated inguinal hernia [6] , [7] , [8] , [9] . These cases were managed by resection of the colon involved with or without a stoma.…”

Perforated diverticulitis of the sigmoid colon contained within an inguinal hernia sac

“…There is only one report of a right-sided inguinal hernia containing a perforatediverticulumum from the right colon 6. An inguinal incision revealed a thickened segment ocecumum densely adherent to the upper pole of the right testisTantiaia et al performed an open righhemicolectomymy with primary anastomosis and en bloc resection of the right testis anepididymisis because of concern for malignancy and inability to safely dissect adherent structures.…”

Strangulated inguino‐scrotal hernia with caecal perforation

“…Incarceration of an intestine within the inguinal hernia occurs in 10% of all cases, potentially developing into more serious complications 3 . The large intestine can be encountered in inguinal hernias 4 ; the caecum usually found as a sliding hernia in right‐sided inguino‐scrotal hernia 5 . We present an unusual case of a strangulated right inguino‐scrotal hernia with contained perforation of the caecum.…”

“…Obstructed inguino‐scrotal hernias containing a perforated caecum is a rare entity. To our knowledge, only three cases have been reported, and all cases described an open operative approach with either midline laparotomy and/or inguinal incision 5–7 . In some instances, bowel resections can be performed solely via the inguinal incision without an additional midline incision.…”

“…3 The large intestine can be encountered in inguinal hernias 4 ; the caecum usually found as a sliding hernia in right-sided inguino-scrotal hernia. 5 We present an unusual case of a strangulated right inguino-scrotal hernia with contained perforation of the caecum.…”