Abstract
A 63-year-old man with left inguinal bulging that had remained untreated for 6 years was evaluated for difficulty in urination associated with hernia enlargement. Physical examination revealed protrusion of a left hernial sac that reached to the knee with the patient standing. The hernia could not be manually reduced. Computed tomography showed protrusion of the small intestine, ascending colon, and sigmoid colon. Surgery was started using a laparoscopic approach, but the hernia was not reducible due to adhesions between the incarcerated bowel and hernia sac, so surgery was converted to an anterior approach. After hernia reduction, the peritoneal cavity was explored laparoscopically. No disruption in blood supply to the bowel was noted, and surgery was completed.
Postoperatively, abdominal compartment syndrome (ACS) was suspected, so the patient was intubated and managed in the intensive care unit (ICU). Mechanical ventilation was required for 4 days because of cardiorespiratory failure associated with ACS, but even after extubation, weaning from noninvasive positive pressure ventilation was difficult. The patient was transferred out of the ICU on postoperative day 11, and was discharged home on postoperative day 24.
This patient with giant inguinal hernia experienced postoperative ACS that could not be avoided even with combined laparoscopy and open surgery. The surgical procedure and perioperative management in such patients must be carefully planned.
