Colon Cancer Presenting as an Incarcerated Incisional Hernia: A Case Report

Colorectal cancer within a hernia sac is rare. Although cases involving inguinal hernias have been reported, colorectal cancer in an incisional hernia has not been documented. A 91-year-old woman with a history of cholecystectomy 30 years earlier presented with melena, hematemesis, and anorexia. CT showed an incisional hernia at the right subcostal region containing the ascending colon with wall thickening and fat stranding, raising concern for incarceration and possible malignancy. Emergency laparotomy revealed an incarcerated ascending colon with a type 2 adenocarcinoma. Right hemicolectomy and primary hernia repair were performed. Histopathology confirmed pT4aN0M0 adenocarcinoma with venous congestion but no tumor rupture or worsening of lymphovascular invasion. The patient was discharged on postoperative day 22. This appears to be the first reported case of colorectal cancer in an incisional hernia. Occult malignancy should be considered in elderly patients with complicated incisional hernias, and early surgery is advisable for irreducible cases.