Scrotal Abdomen : Case Report of a Giant Inguinal Hernia.
PRESENTER – DR KIRAN S P, POST GRADUATE, DEPT OF GENERAL SURGERY, BMCRI
COAUTHOR – DR SANTHOSH C S, ASSOCIATE PROFESSOR, DEPT OF GENERAL SURGERY, BMCRI
INTRODUCTION
▪ Scrotal abdomen are those which extend
below the mid- point of thigh in the
upright position.
▪ These patients usually present later due to
fear of surgery or lack of knowledge for
those living in rural areas.
▪ Reduction of contents in giant inguinal
hernia may lead to cardiopulmonary arrest
due to elevation of intra-abdominal
pressure and elevation of diaphragm
causing Abdominal Compartment
Syndrome. Hence, an extra cautious
approach is needed in managing these
patients.
CASE REPORT
▪ A 75-year-old male presented with
complaints of swelling in right groin since
35-years which was initially reducible and
was not since last 25-years. Patient had
difficulty in walking and performing his
daily activities.
▪ On examination a right sided
Inguinoscrotal swelling with lower end of
the swelling about 25 cm from the root of
scrotum and reaching up to midpoint of
inner thigh in standing position, non-
reducible, cough impulse not made out,
penis pushed to left, each testis was
normal and separately palpable from
swelling and overlying skin was normal.
INVESTIGATIONS
▪ USG: Uncomplicated right MANAGEMENT
inguinal hernia with omentum, ▪ Preoperatively patient was advised with foot end
small bowel and large bowel as elevation and incentive spirometry exercises for 2-
contents . weeks.
▪ Patient was operated under GA. Surgery via
inguinoscrotal approach revealed a indirect inguinal
hernia with contents as small and large bowel with
mesentery and omentum with adhesions to the sac.
▪ Reduction of contents into abdominal cavity was done
through the deep inguinal ring after releasing the
adhesions to sac and excess sac was excised.
▪ Posterior wall strengthening with modified bassinis
and LTF mesh repair was done with no undue tension.
▪ Patient was extubated post operatively, monitored in
Fig. 1 intensive care for 48hrs and discharged on POD 10
without any complications.
CONCLUSION
▪ Proper pre-operative evaluation anticipating cardio-
respiratory compromise and raised intra- abdominal
pressure has to be taken care. Careful intra-operative
manipulation of Hernia contents and adequate post-
operative care watching for raised intra abdominal
pressures can reduce the incidence of cardio respiratory
problems, wound infection and recurrence.
REFERENCES
1. Hodgkinson DJ, McIlrath DC. Scrotal reconstruction for giant
inguinal hernias. Surg Clin North Am 1984; 64: 307-13.
2. Sarakbi W Al. Agarwal A. Taffinder N. A Giant inguinoscrotal
hernia: a case report and review of literature. Grand rounds 2005; 5: 46
3. Serpell JW, Polglase AL, Anstee EJ. Giant inguinal hernia. ANZ
Fig. 2 Fig.3 Journal of surgery. 1988; 58: 831–34.