Case report: Preoperative progressive pneumoperitoneum in giant inguinoscrotal hernia

Abstract

Josefa Elizabeth Aguirre, Hanna Ruiz-Nino, Maria Marcela Medina, Jose Antonio Caballero, Jorge Jesus Pereira

Giant inguinoscrotal hernias are rare surgical entities, generally seen in developing countries, and pose a challenge to sur-geons trying to repair this hernial defect. Therefore, to facilitate the surgical procedure, a progressive pneumoperitoneum technique before surgery has been proposed. Here we describe the case of a 43-year-old male patient who presented to the outpatient surgery office with a giant inguinoscrotal hernia, which had been growing for 11 years and was not associ-ated with any discomfort other than a difficulty in walking. During hospitalization, preoperative progressive pneumoperito-neum generation technique was performed, and intra-abdominal pressure levels were monitored for seven days. Surgical right inguinal hernia repair was performed using the Stoppa technique, exposing a large defect on the posterior wall of the right inguinal canal where the greater omentum bulged out. There was also evidence of small intestine loops and right colon lodged in the scrotum. The hernia sac was reduced and cut with relative ease; the defect was repaired using a mesh implant covering the full area of the Fruchaud’s myopectineal orifice defect in the preperitoneal space, closing the cavity layer by layer until reaching the skin. The patient had a postoperative period with no complications and was discharged on the fifth day.