A Massive Sliding Inguinal Hernia Containing the Entire Right Colon With Caecal Perforation: A Rare Surgical Challenge

Hernias of the abdominal wall result from an area of weakness or defect in the abdominal wall, specifically in the area between the ribs and the hips. It can appear anywhere across the abdominal wall. The most common type of hernia is inguinal, which affects the groove between the abdomen and thigh. We discuss the case of a 75-year-old male who was admitted to the hospital after presenting with a large right-sided inguinoscrotal hernia, which had been gradually growing for the last three years. The patient had acute pain, hard swelling, and redness for the past three days. The general assessment revealed a large irreducible hernia, which was tender in the area of erythema. An emergency CT of the abdomen and pelvis (CTAP) demonstrated a perforated ascending colon with the formation of abscesses within the hernia. The management involved an exploratory laparotomy, which showed evidence of a strangulated hernia; there was extensive ischaemia and congestion of the terminal ileum, cecum, appendix, ascending colon, and omentum. The surgical interventions included right hemicolectomy with ileostomy, drainage of the abscess in the abdominal wall, and hydrocelectomy. Postoperatively, the patient remained in the ICU for two days after the surgery; he developed a minor complication (surgical site infection (SSI) grade 1) and was later transferred to the ward and discharged after a week.