合併膀胱及乙狀結腸侵犯之嵌頓性腹股溝疝氣緊急修補術後

出現模擬復發疝氣的慢性腹股溝假性囊腫：病例報告

蘇一廷、陳祺方

台灣基督長老教會馬偕醫療財團法人馬偕紀念醫院 泌尿科

Chronic Inguinal Pseudocyst Mimicking Recurrent Hernia After Emergency Repair of an Incarcerated Inguinal Hernia With Bladder and Sigmoid Colon Involvement: A Case Report

Yi-Ting Su, Chi-Fang Chen

 Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan

Case presentation:

A 74-year-old man with a long-standing right inguinal hernia presented with acute painful swelling of the right groin on 26 July 2025. Imaging demonstrated an incarcerated right inguinal hernia with involvement of the urinary bladder and sigmoid colon. Therefore, he underwent emergent right herniorrhaphy combined with bladder repair and sigmoid colectomy for gangrenous bowel on 26 July. The postoperative course was uneventful. The wound healed well, and the urethral Foley catheter was removed on 13 August. He was discharged on 16 August. After discharge, the patient noticed a persistent right groin bulge at the operative site. Thus, he was referred to our urology outpatient department for further evaluation.

At our outpatient department on 31 October, he reported no systemic symptoms such as fever, chills, dysuria, or lower urinary tract complaints. His bowel function was normal, and he described only mild local discomfort in the right groin. Physical examination revealed a non-reducible, protruding mass in the right inguinal region without overlying skin changes. There was no evidence of bowel obstruction. Laboratory tests showed a white blood cell count of 6,100/µL and a mildly elevated C-reactive protein of 9 mg/L.

On scrotal and inguinal sonographic examination, the right groin mass was interpreted as either a recurrent inguinal hernia with omental protrusion or a complicated postoperative cystic lesion. A contrast-enhanced computed tomography (CT) scan showed a thick-walled cystic lesion in the right inguinal region with surrounding fat stranding.

A tentative diagnosis of postoperative inguinal seroma or pseudocyst was made. We opted for conservative management with close observation and scheduled follow-up imaging with a testis and scrotum ultrasound. At the time of this report, the patient remained clinically well, and he reported that the right groin mass had gradually decreased in size.

Discussion:

Seroma formation is a well-recognized early complication after inguinal hernia repair. Reported incidences range from approximately 1.9% to 12% following inguinal hernioplasty, with some series suggesting even higher rates when systematic imaging follow-up is used.[1] Most postoperative seromas are small, appear within the first week, and resolve spontaneously within a few weeks without intervention. However, a minority of cases evolve into chronic or encapsulated collections that may require invasive management.

Pathophysiologically, postoperative seroma represents the accumulation of serous fluid or lymph within a surgically created dead space. Extensive tissue dissection, disruption of lymphatic channels, and shear forces between tissue planes all contribute to persistent fluid production and impaired resorption. In the setting of inguinal hernia repair, several risk factors have been associated with seroma formation, including large hernial orifice, large hernia sac (especially inguinoscrotal hernias), obesity, and wide preperitoneal dissection, particularly in total extraperitoneal (TEP) laparoscopic repairs. [2] Emergency surgery with bowel resection and contamination, as occurred in our patient, may further augment the local inflammatory response and predispose to prolonged fluid production.

Recent reviews on postoperative seroma management emphasize that chronic seromas can progress to thick-walled pseudocysts that rarely resolve spontaneously and may ultimately require open drainage and capsulectomy. [3] In the inguinal region, such pseudocysts have been described as “inguinoscrotal pseudocysts,” occasionally reaching large size and causing significant discomfort, with most of the published data limited to case reports and small case series.

Clinically, a postoperative inguinal seroma or pseudocyst can closely mimic hernia recurrence, as both present with a groin bulge at the previous operative site. Careful physical examination, supplemented by ultrasound or CT, is crucial to differentiate between a fluid-filled cavity and a true recurrent hernia containing bowel or omentum.

Management should be individualized according to symptoms, infection risk, and the dynamics of the collection. The majority of uncomplicated seromas can be managed conservatively with observation and reassurance, as they tend to resolve or decrease in size over time. [1] Repeated aspiration may be considered for painful collections, but it carries a risk of introducing infection and may promote capsule formation. For chronic, encapsulated pseudocysts that remain symptomatic or fail to regress, surgical options include open excision of the fibrous capsule with obliteration of the dead space, sometimes combined with adjunctive techniques such as sclerotherapy. [3]

Finally, our decision to pursue close follow-up with serial ultrasound, rather than immediate re-exploration, was based on the stable clinical picture and partial spontaneous regression of the mass. Longer-term follow-up will clarify whether definitive surgical treatment is required.