CASE REPORT   

Chirurgia 2018 April;31(2):70-4

DOI: 10.23736/S0394-9508.17.04742-8

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Strangulated obstruction of megasigmoid loop in right inguinal hernia

Constantinos AVGOUSTOU ✉, Εmmanouil TSANAKALIS

Department of Surgery, Agia Olga Konstantopouleio Peripheral General Hospital, Nea Ionia, Greece

Inguinal hernias may sometime represent a criticality for a surgeon due to their unexpected content, and emergent cases can be a challenge because of their complexity. We report an extremely rare case of a strangulated right inguinal hernia (RIH) containing a segment of megasigmoid colon. The patient, a 77-year-old man, was admitted with bowel obstruction. He was suffering from serious comorbidities, i.e. multiple myeloma, cardiovascular disease and diabetes mellitus. On physical examination he had a strangulated RIH and on CT imaging a segment of sigmoid was revealed as its content. Once emergent midline laparotomy was performed, a segment of megasigmoid was strangulated in a RIH. The colon was freed and was delivered into the abdomen. The entrapped 15-cm-long segment was suffering from severe ischaemia and a focal rupture at the constricting ring was evident. A Hartmann’s procedure, including the entire megasigmoid loop of 50 cm with the ischemic segment, was undertaken. The right internal inguinal ring was closed using sutures from the inside. The patient had an uneventful recovery. Six months later, he underwent a successful large bowel continuity reconstruction combined with a Bassini repair of the RIH.

KEY WORDS: Colonic pseudo-obstruction - Sigmoid diseases - Inguinal hernia