Concomitant management of a large abdominal aortic aneurysm and a giant incarcerated inguinal hernia

The optimal therapeutic approach to a patient who has a large incarcerated inguinal hernia and an abdominal aortic aneurysm (AAA) of significant size is controversial. Here we report a case of a patient who presented with a giant incarcerated inguinal hernia who was found to have an 8-cm AAA. Three surgical options were considered: (1) perform open AAA repair first, followed by hernia repair a few weeks later to allow for recovery, (2) perform hernia repair first followed by AAA repair a few weeks later, or (3) perform both simultaneously as a combination procedure. We successfully performed hernia repair first, followed by open AAA repair as a separate procedure at a later date. We believe that a two-stage approach, performing hernia repair first, is the safest approach to surgical repair of an incarcerated hernia in a patient with an asymptomatic AAA that requires open repair.