An unusual cecal mass on routine colonoscopy

Cecal masses secondary to extra-luminal compression are rare. We report a case of a 72-year-old man with a cecal mass found during routine colonoscopy with multiple biopsies showing normal colonic mucosa. The patient had a relevant past surgical history of a bilateral open inguinal hernia repair using the 'Plug-and-Patch' mesh system. A computed tomography scan of the abdomen and pelvis showed a 4 × 3.3 cm mass that compressed the wall of the cecum. A neoplastic process could not be ruled out. Diagnostic laparoscopy with intraoperative colonoscopy showed that the right hernia plug was not deployed and was causing extrinsic compression of the anterior cecal wall and an intraluminal impression upon insufflation of the colon. This case report reiterates the importance of combining intraoperative colonoscopy with laparoscopy for diagnosis of undetermined colonic masses.