橫結腸絞窄性腹股溝疝氣合併盲腸穿孔：罕見病例報告

黃上瑋¹、邱煜程²

三軍總醫院 ¹外科部 泌尿外科，²外科部 一般外科

Cecal Perforation Secondary to a Rare Strangulated Inguinal Hernia Containing Transverse Colon: A Case Report

Shang Wei Huang, MD¹, Yu Cheng Chiu, MD²

Division of Urology, Department of Surgery¹ and Department of General Surgery², Tri-Service General Hospital, Taiwan

Abstract

Background:

The contents of an inguinal hernia sac are typically composed of the small intestine or omentum. While the involvement of any large bowel segment is infrequent, it most commonly presents as a sliding hernia involving either the sigmoid colon or the cecum. Finding the transverse colon within an inguinal hernia, however, is an exceptionally unusual clinical scenario. The precise reasons for this rare anatomical displacement are not well established, though suggested predisposing factors include a particularly large hernial defect or an abnormally redundant transverse colon.

Case Summary:

A 58-year-old male was admitted for acute peritonitis and abdominal pain, which was accompanied by a non-reducible mass in the right groin. A subsequent abdominal computed tomography scan identified three critical findings: a strangulated transverse colon, significant cecal distension, and evidence of pneumoperitoneum. The patient underwent an immediate exploratory laparotomy. Operative findings confirmed the incarceration and necrosis of the transverse colon within a right-sided indirect inguinal hernia, in addition to a concurrent cecal perforation. The surgical intervention consisted of a right hemicolectomy, the creation of a diverting loop ileostomy, and a primary Bassini repair of the hernia defect. Intraoperatively, the presence of multiple plaques on the mesentery, combined with a shortened mesentery and tethering of intestinal loops, was highly suggestive of underlying sclerosing mesenteritis. Subsequent pathological and serological analyses successfully ruled out both malignancy and autoimmune etiologies. The patient had an uneventful postoperative course and underwent successful stoma closure three months later.

Conclusion:

This report underscores the clinical rarity of an inguinal hernia containing the transverse colon. We propose that the patient's underlying sclerosing mesenteritis, which resulted in significant mesenteric shortening, served as a crucial predisposing factor. This pathological contracture of the mesentery likely facilitated the abnormal translocation of the transverse colon—an atypical visceral component—into the inguinal canal, leading to this unusual presentation.