A Case of an Irreducible Giant Inguinal Hernia Containing the Transverse Colon

Abstract

A 43-year-old man visited our emergency outpatient unit complaining of pain from the scrotum to the right lower quadrant. His scrotum had enlarged to the size of an infant’s head. A CT scan revealed a huge right inguinal hernia containing the omentum and transverse colon. Since the hernia could not be reduced by manipulation, an emergency operation was performed. At first, we attempted to reduce the hernia contents laparoscopically, but we could not. Even after switching to laparotomy surgery we were still unable to reduce the hernia contents, and it was finally possible to return the omentum and transverse colon to their correct position by adding a right inguinal skin incision and expanding the hernia gates. Bowel resection was avoided because the transverse colon showed no evidence of necrosis and perforation. On the other hand, an ischemic change was observed in a part of the omentum so we resected it. The hernia hilum was repaired using a Polysoft^® mesh via an anterior approach. We seldom encounter cases of inguinal hernia containing the transverse colon, although inguinal hernias are a common condition. Recently, the usefulness of laparoscopic hernia repair has been reported, but in this case it was impossible to reduce the hernia contents with only a laparoscopic approach. We report on our case together with a review of the relevant literature.