Giant inguinal hernia with mal-rotation in a resource-limited area: Case report

Giant inguinoscrotal hernias (GIH), defined as hernias extending below the inner thigh midpoint in a standing position, are rare and often seen in resource-limited settings due to delayed medical care. These hernias pose surgical challenges, particularly in low- and middle-income countries (LMICs), where standardized management protocols are lacking, and risks such as cardiorespiratory compromise are significant.

A 55-year-old male presented with a large, irreducible right inguinoscrotal hernia of 1.5 years duration. Elective surgery involved sac separation and laparotomy, revealing herniation of bowel segments, including the terminal ileum and sigmoid colon, with concurrent intestinal malrotation. Ladd's procedure, appendectomy, and hernia repair were performed without complications. Postoperative recovery was uneventful, with the patient remaining asymptomatic during follow-up.

GIH management depends on hernia classification. While Type I hernias require simpler repairs, Types II and III often necessitate advanced techniques, such as Preoperative Progressive Pneumoperitoneum or bowel resection, to prevent abdominal compartment syndrome (ACS). Anatomical anomalies, such as malrotation, complicate surgical planning. Successful outcomes rely on individualized, resource-appropriate strategies and meticulous care, especially in LMICs.

GIH presents unique challenges, particularly in resource-constrained settings. Tailored approaches, informed by classification and patient-specific factors, are essential. This case underscores the importance of innovative strategies, careful planning, and standardized protocols to improve outcomes for GIH patients globally.