Emergency laparoscopic transabdominal preperitoneal repair of bilateral pantaloon hernia presenting with acute small bowel obstruction

Pantaloon hernia (PH) is defined as ipsilateral direct and indirect inguinal hernias. Bilateral PH is an exceedingly rare occurrence. Here, we report a case of a 73-year-old man with a painful, irreducible right groin swelling associated with vomiting and features of small bowel obstruction with bilateral groin swelling noted clinically. Contrast-enhanced computed tomography revealed an indirect hernia on the right containing obstructed small bowel and a left inguinal hernia partially containing the urinary bladder. Diagnostic laparoscopy revealed a bilateral PH with right-sided obstruction. After reducing the obstructed small bowel and checking its viability, the transabdominal pre-peritoneal approach was undertaken to repair the hernial orifices. The post-operative recovery was uneventful, and the patient was discharged on post-operative day 3. Serial follow-ups revealed no complications. This case highlights that, with experience, laparoscopic repair of bilateral PH in emergencies is safe, feasible and a practical alternative to open surgery.