Hybrid Endoscopic-Laparoscopic Management of Colonoscopic Perforation within an Inguinal Hernia Sac

Colonoscopy is the gold standard for colorectal cancer screening, yet it carries the risk of iatrogenic perforation. A rare, hazardous subtype involves colonoscope incarceration and perforation within an inguinal hernia sac, mechanically driven by a "hinge effect" during withdrawal. The confined anatomical space often masks typical peritoneal signs, challenging diagnosis. A case is presented of a 71-year-old male (Body Mass Index: 24.2 kg/m²) undergoing a routine screening colonoscopy. Significant resistance occurred at the sigmoid colon during withdrawal, revealing a 1.0 cm full-thickness defect. First, an immediate endoscopic "damage control" strategy was employed using a through-the-scope purse-string suture technique combining a nylon endoloop with titanium clips to seal the defect acutely within 15 min. Crucially, an emergency contrast-enhanced Computed Tomography (CT) scan performed at Hour 1:00 post-event identified the perforated segment entrapped within a 4 cm left inguinal hernia sac, suggesting surgical exploration over exclusive conservative observation due to visceral ischemia risks. Consequently, the patient underwent laparoscopic partial sigmoidectomy of a 10 cm segment and high ligation of the hernia sac with internal ring closure under a stable 12 mmHg pneumoperitoneum (operative duration: 165 min; blood loss: 15 mL). The patient recovered uneventfully and was discharged on the seventh postoperative day. Quantified follow-up at 1 and 3 months confirmed complete functional recovery and zero recurrence. This case highlights the need for pre-procedural hernia assessment and suggests that a hybrid approach, pairing immediate endoscopic containment with planned surgical repair, may present a feasible alternative pathway for managing this rare emergency.