Strangulated giant inguinal scrotal hernia with traction perforation at lesser curve of the stomach

Abstract

A giant inguinoscrotal hernia is typically associated with a low risk of bowel obstruction or strangulation. When the hernia is complicated with acute gastric perforation, it is an exceedingly rare clinical entity. The operative strategy may be definitive at the index surgery or staged. The technical challenge is the severity of the peritoneal contamination contradicting mesh placement, coupled with the loss of domain. Herein we report a 58-year-old man with a long-standing right giant inguinoscrotal hernia, who presented with strangulation with a 1 day history. An urgent midline laparotomy access revealed a large tear over the lesser curvature of the stomach, attributable to choking at the hernia neck. Furthermore, there was severe contamination with total bowels herniation into the sac. We performed a complete reduction of hernia content, primary repair of stomach perforation, and primary closure of midline access and hernia neck repair with posterior wall reinforcement using prolene via an inguinal incision. The patient made an uneventful recovery and was discharged well. The perioperative clinical events and technical strategies are discussed in the current report.