Abstract
The patient was a 76-year-old man who had been injured when his two-ton fishing boat collided with a ten-ton ship. When he was seen at our hospital, he presented with hypotension, tachypnea and an about 2-cm laceration at the left perineal region. Furthermore he complained of chest pain and bilateral gluteal pain ; and a soft tumor was palpated at the left inguinal region. Contrast-enhanced CT scan of the whole body revealed right hemopneumothorax, multiple fractures of the right ribs, multiple pelvic fractures, hepatic subcapsular injury, intraperitoneal free air, and a left inguinal hernia. In addition an efflux of contrast material from the vessels to the outside structure was observed from the left gluteal region to the abdomen. From these findings, pelvic fractures and traumatic bowel injury were diagnosed. Emergency operation was performed after embolization of the involved vessels and right thoracic drainage. At surgery, we confirmed that the abdominal cavity and the inside of the hernia sac had been contaminated with stool juice and a ruptured sigmoid colon was present. The abdominal cavity was irrigated, the sigmoid colon was partially resected, and an end-to-end anastomosis was done. The internal inguinal ring was simply closed from the abdominal cavity and a drain was placed in the hernia sac through the perineal laceration. As traumatic rupture of the sigmoid colon within the inguinal hernia is very rare, this case is presented together with a review of the literature.
