Incarcerated left indirect inguinal hernia in a male child
Published in the Journal of Post Graduate Medicine, the authors present a case of incarcerated left indirect inguinal hernia in a male child which on exploration revealed the presence of free air and fecal matter containing fluid in the hernial sac.

This is the second reported case of the presence of cecal perforation in left Amyand's hernia in pediatric age group and unique in the sense of the form of abnormal anatomy encountered per-operatively.

A 3-year-old term born male was brought by his parents to the emergency department for inconsolable crying for the past 6 hours. According to the parents, the patient had a small reducible swelling in the left groin first noticed around 6 months of age which had become painful and non-reducible for the past 5 days.

On examination, a tense, tender, warm, indurated, erythematous, minimally fluctuant, transilluminant left-sided inguinoscrotal swelling was seen. The scrotal rugosities were lost, left-sided testis could not be palpated, and the penile tissue was buried under skin with only prepucial covering visible.

Clinically, a strangulated inguinal hernia with reactive fluid in the hernial sac was suspected. X-ray abdomen erect view showed no air-fluid level or free air in the peritoneal cavity or hernial sac. USG demonstrated the presence of bowel loops with free fluid with internal echoes in the left scrotal sac with well-vascularized bilateral testis.

On emergency exploration, initially, a left inguinal crease incision starting at the superficial inguinal ring was given. The incision relieved the tissue pressure around the penis and only then the prepuce and penile skin could be retracted and penile meatus visualized which was catheterized. Hernial sac was thick and tensely distended. When it was opened, a gush of air came out along with fecal matter containing fluid.

Continue to read here: