Scrotal Abdomen: Case Report and Management Principles

Hernias extending beyond the midpoint of the inner thigh in the standing position are called giant inguinal hernias or scrotal abdomen. They are rarely seen in common surgical practice. Huge inguinal hernias occur after years of neglect by the patient or in areas that are inaccessible to surgical services. Two cases of giant inguinal hernias which were managed successfully are presented here. Case 1: 80-year-old male patient presented with left giant scrotal abdomen for the past 12 years. Preoperatively, the pulmonary function test was found to be normal for his age. He was given incentive spirometry for a week. Perioperatively, the sac contained the entire small bowel, sigmoid colon, and omentum with inter bowel loop adhesions. Adhesions were released and it was repaired by hernioplasty with left orchidectomy. In the postoperative period, the patient was put on non-invasive ventilation for two days and then later was weaned off. Case 2: 42 years male patient presented with right-sided giant inguinoscrotal swelling for the past 15 years. The swelling was extending below midthigh. All the preoperative investigations were normal. Perioperatively, the sac contained omentum and small bowel and it was repaired by right hernioplasty. The postoperative period was uneventful and the patient recovered well. These are interesting cases of giant inguinal hernias. The occurrence of such potentially dangerous surgical problems is more common in low-to-middle income countries owing to the unavailability of surgical services. The management involves specific measures to prepare the patient adequately preoperatively especially to prevent respiratory complications in the postoperative period. Giant inguinal hernias can be comfortably managed if the patients are prepared adequately in the preoperative period. Their postoperative period will be uneventful if their pulmonary functions are normal.