A Neglected Case of Right Strangulated Inguinal Hernia Presenting with Fecal Fistula

Abstract

Introduction and importance The groin hernias account for about 75% of ventral hernias. Most of the inguinal hernias asymptomatic and doesn’t warrant intervention. In general, we offer surgery for all symptomatic hernias and asymptomatic hernias likely to cause future complications. Richter’s hernia is a special and uncommon type of hernia where only a part of antimesenteric bowel wall is incarcerated within the hernia sac results in ischemia, gangrene and perforation of hollow viscus [1]. It is commonly described in femoral hernia but rarely may present in inguinal hernia. Lack of awareness about this condition being the commonest reason for delayed diagnosis and increased morbidity [2]. Case summary We present a case of 25 years old male mentally retarded patient presented with spontaneous fecal discharge at right inguinal region after a delayed presentation of strangulated right inguinal hernia. Clinical discussion The most feared and fatal complication of hernia is bowel strangulation. The delayed diagnosis of strangulated hernia can actually transform a benign condition to highly morbid condition. The unnecessary delay in diagnosis and treatment result in various complications like Necrotizing fasciitis, gangrenous testis and spontaneous fecal fistula [2,5]. This emphasizes the need for health education and public awareness to avoid crippling complications. Conclusion Early diagnosis and treatment in the form of emergency surgery are crucial for strangulated inguinal hernia and prevents unnecessary development of the problem with progressive infectious and necrotic destruction of adjacent tissues. There is no a standardized approach on such kind of hernia complications. It is better to approach through the abdomen first and resect the bowel so that the abdomen will be isolated from the infective focus in the groin.