A Case of Incarcerated Inguinal Hernia Causing Sigmoid Colon Perforation in the Hernia Sac

Abstract

An 80-year-old man attended an outpatient clinic complaining of vomiting and left inguinal pain. There was a large, tender protrusion extending from the left inguinal region to the scrotum. Computed tomography showed that the sigmoid colon was incarcerated in the left scrotum, which contained free gas and feces. There was no sign of free gas or ascites in the peritoneum. A left incarcerated inguinal hernia causing sigmoid colon perforation in the hernia sac was diagnosed, and emergency surgery was performed. When the abdomen was opened, the sigmoid colon was found to be incarcerated in the left lateral inguinal hernia sac, and when it was reduced, a perforation was visible in the mesenteric attachment of the part of the sigmoid colon that had been in the hernia sac. There were no signs indicating either a tumor or a diverticulum at the perforation site or of ischemic necrosis. Hartmann's operation and hernia sac resection and suturing were performed. Postoperatively, the patient developed congestive heart failure and ileus, but these improved with conservative therapy, and he was discharged on postoperative Day 40. We considered that vomiting while the sigmoid colon was incarcerated had caused a sudden increase in intra-abdominal pressure, generating a pressure difference between the hernia sac and the peritoneal cavity that may have caused the perforation. A rare case of sigmoid colon perforation inside an inguinal hernia sac is reported.