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

Area of Science:

• Gastroenterology
• Surgical Emergency Management
• Abdominal Surgery

Background:

• Strangulated inguinal hernias necessitate urgent surgical intervention to prevent bowel compromise.
• While intra-canalicular bowel perforation is documented, proximal intraperitoneal perforation is exceptionally rare.

Observation:

• A 44-year-old male presented with a strangulated right inguinal hernia and peritonitis.
• Exploratory laparotomy revealed two perforations in the proximal ileum, which were successfully sutured.
• The strangulated bowel segment within the inguinal canal was viable and reduced.

Findings:

• Primary closure of proximal ileal perforations was achieved.
• The inguinal hernia was repaired using the nylon Darning technique via a separate inguinal incision.
• The patient experienced a full recovery without hernia recurrence at six months.

Implications:

• This case demonstrates a feasible surgical approach for managing rare intraperitoneal bowel perforations secondary to strangulated inguinal hernias.
• It underscores the importance of tailored surgical strategies based on the specific intra-abdominal pathology encountered.
• Successful management preserves bowel viability and achieves durable hernia repair.