Strangulated Inguinal Hernia With Intraperitoneal Proximal Bowel Perforation: An Unusual Presentation

Strangulated inguinal hernias are a common surgical emergency that requires prompt intervention to save the bowel. Perforation of the strangulated bowel loop inside the inguinal canal due to delayed presentation is known, but the occurrence of intraperitoneal proximal bowel perforation is exceedingly rare. This poses a unique challenge in terms of the surgical incision required and the type of hernia repair to be done. This case report describes a 44-year-old male who presented with a strangulated right inguinal hernia along with peritonitis. A midline exploratory laparotomy revealed two perforations in the proximal ileum, which were sutured primarily. The entire bowel was checked for any obvious gross pathology. The bowel wall did not appear inflamed, thickened, or constricted at any point. The strangulated bowel in the inguinal canal was viable and was reduced successfully, and the hernia was repaired through a separate inguinal incision using the nylon Darning technique. The patient had a full recovery with no recurrence at six-month follow-up.