A Case of Left Inguinal Hernia with Endoscopic Incarceration During Colonoscopy Treated by Laparoscopic Surgery and Intraoperative Colonoscopy

Abstract

The patient was a 73-year-old male who was aware of a swelling in his left inguinal region, but had never been diagnosed as having a left inguinal hernia. He was admitted to our hospital for colonoscopy because of a positive result of the fecal occult blood test. During the colonoscopy, we were unable to withdraw the endoscope, and at the same time, the patient complained of severe lower abdominal pain. Examination revealed a reddish swelling in the left inguinal region. Abdominal CT revealed incarceration of the sigmoid colon along with the endoscope in the hernia sac. An immediate attempt at manual reduction was unsuccessful, and we decided to perform emergency operation. Laparoscopic surgery was performed, the diagnosis of indirect hernia was made, and the incarceration was relieved by intra-abdominal operation and external manual reduction; however, serosal injury was noted in a part of the sigmoid colon. As intraoperative endoscopy showed no obvious mucosal necrosis, no sigmoid resection was performed, but the serosal injury was repaired under direct vision. The hernia hilum was repaired using the Lichtenstein method. Incarcerated hernia as a complication of colonoscopy has rarely been reported so far. We treated the patient by a minimally invasive and safe treatment method: laparoscopic surgery and intraoperative endoscopy.