Incarcerated lateral inguinal hernia following ilioinguinal lymph node dissection: an unusual case

Penile squamous cell carcinoma (SCC) spreads predictably from primary tumour to inguinal lymph nodes then pelvic nodes and finally, to distant sites. Inguinal dissection involves resection of all femoral and inguinal nodes and is part of the recommended management. Femoral hernias are a commonly reported consequence of these extensive dissections. This case describes an unusual hernia which developed lateral to the femoral vessels. A 68 year old man presented with penile SCC of the distal glans penis and underwent bilateral ilioinguinal node dissections for nodal recurrence. On post operative day 1, the patient developed abdominal distention and obstipation. He returned to theatre and a defect under the inguinal ligament, lateral to the femoral vessels was identified, consistent with a lateral hernia. This was repaired with a polypropylene mesh onlay. Lateral inguinal hernia is a rare occurrence after ilioinguinal node dissection but early recognition and prompt intervention can prevent significant morbidity.