Treatment of a half century year old giant inguinoscrotal hernia. A case report

INTRODUCTION: Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient’s rejection of timely surgical management. PRESENTATION OF CASE: A 77 year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery. DISCUSSION: Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a ‘V shaped’ incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day. CONCLUSION: Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.