Strangulated inguinal hernia of the bladder and intestinal necrosis

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Letter to the Editor
Corresponding author:
Serhat Doğan
Department of
General Surgery
Malatya Education
and Research
Hospital
44000 Malatya, Turkey
Phone: +90 5069306797
E-mail: drserhatdogan@
gmail.com
1
Department of General Surgery, Malatya Education and Research Hospital, Malatya,
Turkey
2
Department of Surgery, Faculty of Medicine, Necmettin Erbakan University, Konya,
Turkey
Submitted: 11 March 2017
Accepted: 3 April 2017
Arch Med Sci Civil Dis 2017; 2: e87–e88
DOI: https://doi.org/10.5114/amscd.2017.67219
Copyright © 2017 Termedia & Banach
Strangulated inguinal hernia of the bladder
and intestinal necrosis
Serhat Doğan1, Mehmet Erikoglu2
Inguinal hernia is acommon problem. Occasionally surgeons are sur-
prised with unconventional structures [1]. The most frequently incarcer-
ated organs are the small intestines, omentum and colon [2]. Adhesions
and bands that form in the inguinal hernia can cause strangulation and
intestinal perforation [3]. In the inguinal hernia sac the bladder is very
rare [4]. In this case of strangulated inguinal hernia operation, we found
necrotic bowel and bladder in the hernia sac. An 80-year-old male patient
had amass in the right groin with swelling, abdominal pain, nausea and
vomiting, and inability to defecate, and so he came to the emergency
department with these complaints.
On examination, the right inguinal skin rash, edema, and apainful
palpable mass measuring about 6 × 8 cm was detected. Abdominal dis-
tension, rebound and defense were positive. Normal leukocytes in labora-
tory tests, urea: 180 mg/dl, creatine: 2.62 mg/dl, C-reactive protein (CRP):
199.92 mg/l were measured. Directly abdominal radiography showed the
air-fluid level in the small intestine (Figure 1). The patient was diagnosed
with strangulated inguinal hernia and operated on.
In the operation the small bowel was necrotic and perforation was
detected at 20 cm in multiple segments of the small bowel in the hernia
sac. The bladder was also found to be necrotic. Because of the dirty and
infected abdomen, the necrotic small bowel was resected and double
barrel ileostomy was performed. We irrigated the abdomen with plenty
of saline. Partial cystectomy of the bladder was performed. In the post-
operative period the intubated patient was taken to the intensive care
unit. On the first postoperative day the patient died because of cardiac
arrest and multiorgan failure.
The bladder and small bowel with both of them necrotic have not
been reported in the literature. As aresult, in cases of strangulated in-
guinal hernia in elderly patients who are operated on for strangulated
hernia we should also keep in mind the bladder.
Conflict of interest
The authors declare no conflict of interest.

Serhat Doğan, Mehmet Erikoglu
e88 Arch Med Sci Civil Dis 2017
References
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Figure 1. Direct abdominal radiography showed
the air-fluid level in the small intestine