Central and West Texas
Las Palmas Medical Center
inguinal hernia, sigmoid diverticulitis, non-incarcerated
Digestive System Diseases | Gastroenterology | Internal Medicine | Surgical Procedures, Operative | Therapeutics
Introduction: Abdominal wall hernia is defined as a protrusion of a part or whole organ through the wall of a cavity. Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women. Indirect inguinal hernia account for 80% of total inguinal hernias. A wide variety of pathological processes can present as inguinal hernias however, large reducible inguinal hernias are quite rare. Recent studies have associated abdominal wall hernia with colonic diverticulosis, a term referred to as herniosis. This association suggests that an underlying connective tissue disorder could be a common etiological factor in abdominal wall hernias and direct inguinal hernias. Approximately, 10-20% of diverticula progress to diverticulitis which along with inguinal hernias are common diseases processes encountered in clinical practice separately, however, the occurrence of these two conditions in tandem is a rarity.
Case: Here we represent a case of a 51-year-old man who presented to our emergency department with an erythematous and extremely tender left scrotum. Upon further examination and radiological imaging, patient was found to have a non-incarcerated sigmoid colon herniating through the inguinal canal who then developed an uncomplicated diverticulitis in the herniated segment. Patient was managed medically for his diverticulitis and surgery was consulted for possible surgical repair. Diverticulitis was treated with IV antibiotics and patient was scheduled for a surgical repair of his hernia in 4-6 weeks after acute diverticulitis symptoms subside, to reduce the risk of complication.
Discussion: Large inguinal-scrotal (indirect) hernias are an uncommon pathological condition in modern clinical practice however, when present, can become challenging to manage. Diverticulitis in the herniating bowel segment is an unusual complication of abdominal wall hernias which can lead to hemorrhage, abscess, fistula formation, bowel obstruction and perforation. In such patients, timely intervention and close monitoring can reduce risk of complications. Patient with such presentation can be managed medically for their diverticulitis initially and once stabilized, the hernia can be surgically corrected.
Publisher or Conference
Texas Chapter of the American College of Physicians
Khan U, et al. Non-Incarcerated Inguinal Hernia with Sigmoidal Diverticulitis. Poster presented at: Texas Chapter of American College of Physicians; October 25-27, 2019; San Antonio, TX.