A Case Of Irreducible Indirect Hernia Caused By Sigmoid Carcinoma Hernia Into Right Groin And Literature Review

Objective: To explore the characteristics,diagnosis and treatment of irreducible indirect hernia caused by sigmoid carcinoma hernia into the right groin,so as to improve the understanding of this kind of disease,reduce missed diagnosis and improve the prognosis of patients.Methods: A case of irreducible indirect hernia caused by sigmoid carcinoma hernia into the right groin was reported in our hospital.Meanwhile,the literature related to this case at home and abroad was searched through PubMed,Medline,CNKI and Wanfang Medical Network,and the diagnosis and treatment methods of this kind of disease were summarized.DATA: The male patient was admitted to hospital mainly because of "right inguinal mass for more than 60 years,progressive enlargement for 3years and pain for half a month".Physical examination: The scrotum on the right side is obviously enlarged,and a lump seems to be palpable in the scrotum,which cannot be returned to the abdominal cavity when lying down.Thoracic and abdominal CT(2020-09-24)showed that the continuity of the right lower abdominal wall muscle was not good,the right groin area showed hernia of rectum,sigmoid colon and surrounding blood vessels(including inferior mesenteric artery),the sigmoid colon wall was thickened,the enhancement scan showed uneven and obvious enhancement,and the surrounding fat space was unclear.Imaging diagnosis: the sigmoid colon wall is thickened,which accords with the manifestation of cancer;Right inguinal hernia.The patient was diagnosed clearly.After no obvious surgical contraindications were found,he was transferred to open radical sigmoidectomy,end-to-end anastomosis of descending colon and rectum+right inguinal hernia repair during laparoscopic exploration on September 28 th,2020.The operation went smoothly.The patients were treated with anti-infection,rehydration and nutritional support,and recovered well after operation.They were discharged smoothly 11 days after operation.Postoperative pathology: sigmoid carcinoma(T4N0M0)stage Ⅱ.The patient was followed up to March 1,2021,and no recurrence of inguinal hernia and tumor metastasis were found.Results: A total of 37 eligible literatures were collected,including 45 patients.All patients were male,aged 44-95 years,with a median age of 72 years.Among them,27 patients(60.0%)were diagnosed before operation,and15 of them were diagnosed by CT.X-ray diagnosis in 4 cases.Hernia contents mainly include sigmoid colon tumors in 35 cases(77.8%),cecal tumors in 5cases(11.1%),transverse colon tumors in 3 cases(6.7%)and ascending colon tumors in 2 cases(4.4%).Among them,28 cases have detailed surgical records,and the surgical methods include: laparoscopic surgery in 2 cases(7.1%),laparoscope combined with laparotomy in 4 cases(14.3%),and simple laparotomy in 22 cases(78.6%).For the choice of surgical approach,15 cases(53.6%)were treated with inguinal incision combined with inguinal incision.Inguinal incision was used only in 7 cases(25.0%).2 cases(7.1%)simply used abdominal median incision.Only 2 cases(7.1%)were treated by abdominal median incision.One case(3.6%)was treated with right abdominal transverse incision under umbilicus.Transverse incision of left iliac fossa was used in 1 case(3.6%).Conclusion: The content of inguinal hernia is colorectal tumor,which is relatively rare and easy to be missed and misdiagnosed.CT is the main diagnosis and differential diagnosis method,and surgery is the main treatment method.