Bilateral inguinoscrotal hernia with gastric contents and subsequent perforation: Lessons in operative management

Introduction: Inguinoscrotal hernias often contain bowel, but it is rare to see it contain part or all of the stomach. These patients tend to present in extremis.

Presentation of case: This is the case of a 74 year old gentleman who presented in obstruction and acutely unwell from giant bilateral inguinoscrotal hernias. CT scan confirmed the left hernia contained the majority of the bowel and stomach. He underwent laparotomy and repair of the left sided hernia. Intraoperatively he was also found to have a gastric perforation and underwent distal gastrectomy. 7 days post operatively he returned to theatre for repair of his right sided hernia. The patient made a full recovery.

Discussion: Review of similar literature highlights numerous surgical methods in repairing these hernias. A two-stage approach appears to mitigate the risk of abdominal compartment syndrome, whilst also allowing for an interval hernia repair in a non-hostile environment. Gastric perforation repair technique also varies, with majority of literature reporting primary repair.

Conclusion: We hope our approach to management can help guide others faced with similar challenging cases. Moreover, it highlights some operative challenges including dealing with associated gastric perforation and mitigating the risk of abdominal compartment syndrome.