Giant Incarcerated Inguinoscrotal Hernia with Small Bowel Obstruction in an Elderly Male Successfully Managed by Emergency Hernioplasty: A Case Report

Abstract

Background

Giant inguinoscrotal hernia is a rare form of inguinal hernia extending below the midpoint of the inner thigh in standing position. These hernias are uncommon in modern surgical practice because of improved access to elective surgical care; however, neglected cases may present with serious complications such as incarceration, intestinal obstruction, strangulation, urinary problems, and impaired mobility. Surgical management remains challenging because of distorted anatomy, dense adhesions, and loss of abdominal domain.

Case Presentation

We report a case of a 68-year-old male presenting with abdominal pain, distension, vomiting, constipation, and painful right inguinoscrotal swelling of 15 years duration. Examination revealed a giant irreducible right inguinoscrotal hernia extending below the midpoint of the thigh with features of intestinal obstruction. Imaging studies, including contrast-enhanced computed tomography, demonstrated ileal loops, cecum, appendix, and omentum within the hernia sac causing small bowel obstruction without gangrene or perforation.

The patient was managed with preoperative resuscitation followed by emergency surgery through a right inguinal approach. Intraoperatively, dense adhesions and viable bowel loops were noted. Adhesiolysis and reduction of contents were performed successfully, followed by Lichtenstein tension-free mesh hernioplasty. Postoperative recovery was uneventful, and no recurrence or respiratory complications were observed during follow-up.

Conclusion

This case highlights the importance of early diagnosis, appropriate preoperative optimization, and meticulous surgical management in achieving favorable outcomes in giant incarcerated inguinoscrotal hernias complicated by intestinal obstruction.