The Stone Within: A Rare Case of an Incarcerated Inguinal Hernia With a Giant Fecaloma

Chronic constipation can lead to severe complications, including the formation of fecalomas, which may result in intestinal obstruction. Inguinal hernias, among the most prevalent abdominal wall hernias, can become incarcerated, leading to obstruction and ischemia. However, the occurrence of an incarcerated inguinal hernia containing a fecaloma is exceedingly rare. We present a case of a 72-year-old male who presented with a progressively enlarging left inguinal mass, urinary incontinence, and chronic diarrhea. Imaging studies revealed a significantly large left inguinoscrotal hernia containing the sigmoid colon impacted by a 4-kg fecaloma. Attempts at conservative disimpaction were unsuccessful, necessitating surgical intervention. The patient underwent a sigmoid colectomy with side-to-end colorectal anastomosis, hernia repair with prosthetic reinforcement, and a diverting ileostomy. This case highlights the importance of tailored surgical approaches in managing uncommon complications stemming from chronic constipation.