Straining induced spontaneous bowel transection in a patient with incarcerated inguinal hernia with cryptorchidism: A...

The pooled prevalence of inguinal hernia worldwide is reported as 7.7 %. Out of all inguinal hernia cases, 10 % of cases get incarcerated whereas strangulation occurs in 0.29 % to 2.9 % of cases. The mortality rate of strangulated inguinal hernia is 2.6 % to 9 %. Although cough-induced spontaneous bowel transection in incarcerated inguinal hernia has been reported, straining induced spontaneous bowel transection has never been reported in the literature.

40 year male presented with irreducible swelling in right inguinoscrotal region, vomiting and unable to pass stool/flatus for 4 days. On examination, there was irreducible swelling at right inguinoscrotal region, separately palpable left testis and non-palpable right testis with signs of peritonitis. On inguinoscrotal exploration, the hernial sac contained 10 ml of toxic fluid with a viable but spontaneously transected ileal loop. So, hand-sewn ileoileal anastomosis with darning repair with right orchidectomy was done.

An intraluminal pressure of 150-260 mm of Hg is required for bowel transection. In incarcerated hernia, bowel loops are edematous, and repeated episodes of straining during defecation can lead to an elevation of intraluminal pressure up to 230 mm of Hg, which is enough to cause transection of the edematous bowel.

In incarcerated hernia, since the bowels are edematous, even repeated episodes of coughing or straining can cause bowel transection. Untreated undescended testis is at higher risk of developing malignancy after 10 years of age. Similarly, restoration of fertility is not seen even on orchidopexy. So, orchidectomy is recommended in adult.