Ramiro Gálvez-Valdovinos1*, Juan Francisco Funes-Rodríguez1, Gustavo López-Ambriz1, Luis L Tinoco Téllez1 and Luis Gerardo Domínguez Carrillo2
1Surgery Division, Hospital Angeles Leon, Guanajuato, México
2Medicine School from Leon, Guanajuato University, Mexico7>
Received: 13 May, 2017; Accepted: 05 July, 2017; Published: 06 July, 2017
Ramiro Galvez Valdovinos, Surgery Division, Hospital Angeles Leon, Guanajuato, México, Tel: (52) 477 78-78-623; E-mail:
Valdovinos RG, Rodríguez JFF, Ambriz GL, LLT Téllez, Carrillo LGD (2017) Laparoscopic surgery without peritoneal space contamination in perforated acute abscedated diverticulitis of incarcerated inguinoscrotal hernia. Arch Clin Gastroenterol 3(3): 063-065. 10.17352/2455-2283.000040
© 2017 Valdovinos RG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Perforated diverticulitis; Incarcerated inguinoscrotal hernia; Acute scrotum
Sixty seven year old male patient with hypotension, tachycardia, 38.5°C fever, tensioning left inguinoscrotal hernia and hyperemia (acute scrotum). By abdominal computed tomography, recto-sigmoid perforation in diverticulitis area with collection and free air in hernial sac, was observed. This clinical finding of perforated abscedated diverticuitis with an inguinoscrotal hernia is uncommon. Usefulness of minimally invasive surgery for Hartmann’s procedure without peritoneal contamination as well as surgical piece removal via scrotum is discussed, including a literature review.
Relation of perforated abscedated diverticuitis with an inguinoscrotal hernia (ISH) is uncommon. There are no cases report published in literature in patient’s clinical context. One of most serious complication of an inguinal hernia is to become incarcerated, the inguinal hernia sac most frequently contains the intestine and the omentum and more uncommonly the appendix, like the sigmoid colon is extraordinary found in an inguinal hernia, especially on the right side. We present a case of this class in which for to extract the contaminated specimen, a minimally invasive surgery to remove sigmoid was combined with trans-scrotal via, achieving resolution of the problem.
Sixty seven year old male patient who refers a 10 years’ evolution of an inguinoscrotal hernia, with no other relevant background, came to emergency room at Hospital Ángeles León, due to a sudden hernia growth, pain, 38.5°C fever, changes in intestinal habits and general bad condition. When clinically explored, he presented hypotension (AT 90/60), tachycardia (113 beats/minute), fever (38.5°C). Abdominal exploration showed inguinoscrotal hernia with hyperemia (Figure 1), pain palpation and tensioning scrotum. Blood cytometry revealed leukocytosis of 15,000/mm3 with 12 bands. Abdominal CT scan (Figure 2) showed inguinoscrotal hernia incarcerated by sigmoid rectum which demonstrated perforated diverticulitis. Patient was admitted in intermediate care unit for shock recovery and broad spectrum antibiotic. Twelve hours later, patient undergone exploratory laparoscopy. During surgery, sigmoid rectum was observed trapped in the hernia, there was no free fluid in peritoneal cavity, end descending colon resection was performed, starting with meso-colon release with harmonic scalpel followed by linear cutting staples, colon reduction was not attempted in order to avoid peritoneal cavity contamination. Simultaneously, other surgeons approached the scrotum (Figure 3) for in bloc extraction preserving the hernia sac with sigmoid rectum and testicle with its elements (Figure 4). Hernia zone was directly closed with continuous non absorbable suture without mesh placement. Penrose drainage was left in scrotum and surgery was concluded with terminal colostomy opening on right iliac fossa. Ertapenem sensibility to Escherichia coli was found in exudate culture. Patient overcome was successful and with no complications, he was discharged 5 days post-surgery with intramuscular ertapenem for home application. Histopathologic study revealed acute perforated diverticulitis with ischaemia in the resected colon segment, ischaemia free resection margins and diverticular disease. Laparoscopic Hartmann’s reversal was performed three months later, repairing hernia by inguinal via and placing mesh. In one year of follow-up the patient is normal and carries out its usual activities.
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