Preoperative evaluation of patients with inguinal hernia for colorectal disease

In retrospective series, 17.0 to 25.5 per cent of those patients with carcinoma of the colon or rectum have been found to have concurrent inguinal herniation. This observation prompted the recommendation that patients with hernias be thoroughly screened for disease of the colon and rectum. That recommendation remains controversial in part because it has not previously been prospectively evaluated. In a one year period, 202 consecutive patients with inguinal hernias completed a preoperative protocol which included: 1, gastrointestinal history; 2, rectal examination; 3, testing of at least two stool specimens with the Hemoccult (Smith Kline Diagnostics) device; 4, sigmoidoscopy, and 5, barium enema. Malignant and premalignant diseases were discovered in five patients, only one of whom had gastrointestinal symptoms. Each malignant lesion was localized (Dukes' A or B) and, therefore, highly curable. Benign disease was found in 49 patients, including polyps in eight and one instance of tight sigmoid stricture. All of the malignant and 91 per cent of the benign lesions were in patients 50 years of age and older. The association between inguinal herniation and colorectal disease was previously attributed to luminal obstruction. In the present series, however, the sole obstructing lesion was a benign stricture. Another explanation for this association must, therefore, be sought. We conclude, on the basis of the results of this experience, however, that screening for pathologic factors of the colon and rectum is warranted in otherwise asymptomatic patients who are more than 50 years old and who present with inguinal hernias.