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

Abstract

We present a patient with perforated diverticulitis contained within an inguinal hernia sac—a diagnostic and treatment dilemma. A 61-year-old man presented to the emergency department with left testicular and groin pain, and loose stool. CT imaging showed a left inguinal hernia containing a perforated segment of sigmoid colon. A segmental sigmoidcolectomyy and end colostomy Hartmannn’s procedure) was performed after reducing the incarcerated inguinal contents. The inguinal hernia was not repaired because of faecal contamination of the hernia sac and risk for recurrence. Pathological examination of theresectedd bowel specimen showed perforated sigmoid diverticulitis in an inguinal hernia sac. The patient had an uneventful recovery and is awaiting definitive inguinal hernia repair andtakedownn of his colostomy.

Sigmoid Diverticulitis in a Tight Spot: An Atypical Presentation Within a Ventral Hernia

“…This was the approach used by Kouraklis et al for an incarcerated groin hernia containing a perforated single diverticulum and it is the principle applied in our case [19]. The second option is Hartmann's procedure through a midline laparotomy [13,14,18], and in cases where conversion from groin to midline incision, a Bassini repair of the groin incision may be performed [13].…”

“…We found eight cases of diverticular abscess manifesting as a complicated groin hernia [3,4,7-10], and 10 reports of diverticulitis being a content of groin hernia sac. Among these cases, one was cecal diverticulitis [11], another was transverse colon diverticulitis [5], and the remaining ones involved the sigmoid colon [12][13][14][15][16][17][18][19].…”

Perforated Sigmoid Diverticulitis Within a Strangulated Inguinal Hernia

“…Perforated diverticulitis within a strangulated hernia is a rare entity for which only a few cases have been reported in the literature. 2 In addition to careful assessment of the patient, optimization of attempts at nonoperative management should be employed. These include appropriate fluid resuscitation, correction of electrolytes and other laboratory derangements, bowel decompression and rest, and "gastrograffin challenge" when possible.…”