Strangulated inguinal hernia of the bladder and intestinal necrosis

Abstract

Inguinal hernia is a common problem. Occasionally surgeons are surprised with unconventional structures [1]. The most frequently incarcerated organs are the small intestines, omentum and colon [2]. Adhesions and bands that form in the inguinal hernia can cause strangulation and intestinal perforation [3]. In the inguinal hernia sac the bladder is very rare [4]. In this case of strangulated inguinal hernia operation, we found necrotic bowel and bladder in the hernia sac. An 80-year-old male patient had a mass in the right groin with swelling, abdominal pain, nausea and vomiting, and inability to defecate, and so he came to the emergency department with these complaints.On examination, the right inguinal skin rash, edema, and a painful palpable mass measuring about 6 × 8 cm was detected. Abdominal distension, rebound and defense were positive. Normal leukocytes in laboratory tests, urea: 180 mg/dl, creatine: 2.62 mg/dl, C-reactive protein (CRP): 199.92 mg/l were measured. Directly abdominal radiography showed the air-fluid level in the small intestine (Figure 1). The patient was diagnosed with strangulated inguinal hernia and operated on.In the operation the small bowel was necrotic and perforation was detected at 20 cm in multiple segments of the small bowel in the hernia sac. The bladder was also found to be necrotic. Because of the dirty and infected abdomen, the necrotic small bowel was resected and double barrel ileostomy was performed. We irrigated the abdomen with plenty of saline. Partial cystectomy of the bladder was performed. In the postoperative period the intubated patient was taken to the intensive care unit. On the first postoperative day the patient died because of cardiac arrest and multiorgan failure.The bladder and small bowel with both of them necrotic have not been reported in the literature. As a result, in cases of strangulated inguinal hernia in elderly patients who are operated on for strangulated hernia we should also keep in mind the bladder. Conflict of interestThe authors declare no conflict of interest.

A rare case of bladder gangrene associated with inguinal hernia: case report

“…A similar case of strangulated right inguinal hernia with bowel and bladder necrosis have been reported by Doğan et al 7 It was a case of elderly male with right IBH with multiple perforation of bowel and double barrel ileostomy and partial cystectomy was done and patient expired on postoperative day 5. In contrast, our patient being middle aged male with left sided strangulated hernia we did resection and anastomosis of gangrenous ileum with partial cystectomy.…”

“…6 Strangulated inguinal hernia with bladder gangrene is an extremely rare entity and only one case has been reported so far. 7 Here we report a case of strangulated left inguinal hernia with bladder and ileal gangrene probably the second ever reported in literature.…”