Emergency involving four intra-abdominal pathologies

Patients in the emergency department usually present with a defined condition that can be treated. More often than not, a cause leads to a pathology that is the leading symptom, such as sigmoid carcinoma with caecal perforation. However, we very rarely see three different conditions that lead to another and require emergency treatment. We report the case of a 70-year-old male who presented with ileus, peritonitis and an incarcerated inguinal hernia. We found a gastric perforation and a desmoid tumour of the small intestine in the incarcerated inguinal hernia. An ileocecal resection, gastric suturing and a Shouldice hernioplasty were performed. The correlation between the pathologies was presumably a gastric perforation with paralytic ileus and subsequent incarceration of the existing hernia. It is important to carefully examine the abdomen for incidental findings during every operation. In cases of multiple pathologies, the connection must be explainable to ultimately resolve all problems.