Surgical management of a giant inguinoscrotal hernia: A case report

Inguinal hernias are among the most common clinical entities encountered by general surgeons. Most defects are small, relatively benign, and easily repaired using standardized and broadly accepted techniques. Large hernias that extend below the mid-point of the inner thigh in the standing position, known as giant inguinal hernias (GIH), are uncommon in the Western world. We present the case of a 71-year-old man who presented with a giant left inguinoscrotal hernia that extended below the knee and was complicated by symptoms of intractable constipation, exercise intolerance, and weakness. This hernia was repaired utilizing an open abdominal midline approach, with retroperitoneal reinforcement of the fascial defect using prosthetic mesh according to the method first described by Stoppa. A long segment of sigmoid colon was entrapped within and densely adherent to the scrotum, necessitating segmental resection with creation of an end colostomy. This was reversed in a subsequent procedure. Several months after his operation, the patient has returned to normal activities without recurrence of prior abdominal symptoms. Although challenging even in the hands of experienced surgeons, surgical correction remains the only mode of treatment that offers patients with GIH satisfactory quality of life.