Inguinal herniation justifies sigmoidoscopy

Controversy exists concerning the association of inguinal hernia and colonic carcinoma and, more specifically, whether the development of an inguinal hernia justifies sigmoidoscopy. To study the role of endoscopic screening in cases of inguinal hernia, we prospectively evaluated 464 patients with inguinal hernia over a 54-month period with flexible sigmoidoscopy. Each patient was over the age of 40 and male. Sigmoidoscopy documented polyps (97 patients, 21 percent) and carcinoma (22 patients, 5 percent). Multiple neoplasms were observed in 6 percent (7 of 119 patients). Occult blood was detected in the fecal specimens of 8 percent of the total group of patients, but in only 13 percent of the patients with polyps or carcinomas. A normal examination occurred in only 38 percent of the total group. By using the presence of an inguinal hernia in patients older than 40 years of age as an indication for sigmoidoscopy, we found that more than one of every four patients had an asymptomatic, concurrent malignant or premalignant colonic lesion. Flexible sigmoidoscopy should be used for screening colonic neoplasms in patients with inguinal hernia.