S6261 Gastric Antrum Perforation Within a Chronic Inguinal Hernia: A Rare Case of Stomach-Containing Groin Hernia With Successful Staged Management

Introduction: Stomach herniation through the inguinal canal is exceedingly rare, with fewer than 100 cases reported since 1802. The stomach is typically stabilized by 4 peritoneal ligaments and therefore is resistant to displacement. However, chronic traction via a longstanding hernia can overcome this arrangement, leading to downward migration, vascular compromise, and complications such as outlet obstruction or perforation. We present a rare case of gastric antrum perforation within a chronic inguinal hernia, managed with a 2-stage surgical strategy. Case Description/Methods: A 58-year-old man with chronic kidney disease stage 3 and a 10-year history of a reducible right inguinal hernia presented with new-onset groin pain, epigastric burning, and obstipation. On examination, the hernia was tender and irreducible. Labs showed white blood cells 15.2 × 10⁹/L, lactate 4.0 mmol/L, and stable creatinine. Computed tomography (CT) revealed herniation of the distal gastric body, gastric antrum, small bowel, and colon into the inguinal canal with wall thickening. He was resuscitated and taken for emergent laparoscopy, which revealed a 2 cm anterior antral perforation. The defect was repaired, and the peritoneum was irrigated. Herniorrhaphy was deferred due to contamination. Postoperatively, he required intensive care unit-level care, mechanical ventilation, vasopressors, total parenteral nutrition, and intravenous antifungals for Candida dubliniensis pneumonia. He improved clinically and was extubated on day 7. By day 8, he was transferred to the floor, with plans for elective outpatient hernia repair. Discussion: This case illustrates a rare but severe complication of chronic inguinal hernias. Sustained tension on the greater omentum and gastrocolic ligament allowed for descent of the gastric antrum, resulting in vascular compromise and perforation. CT imaging was key to preoperative diagnosis. A 2-stage approach—initial source control with delayed hernia repair—was employed to minimize prosthetic mesh infection risk, aligning with HerniaSurge and World Society of Emergency Surgery guidelines. Literature review confirms the safety of this strategy and underscores the high morbidity in cases where simultaneous mesh repair was performed. This case also adds to limited evidence of Candida species complicating postoperative recovery. Early recognition of upper gastrointestinal symptoms in patients with chronic groin hernias is crucial, as rapid surgical intervention can be lifesaving.