Transverse Colon Necrosis Secondary to Strangulated Right Inguinoscrotal Hernia: A Rare Surgical Emergency

Background: Inguinoscrotal hernias are common in elderly males. Although incarceration and strangulation are well-known complications, involvement of the transverse colon with subsequent necrosis remains uncommon and may present without classical signs of bowel obstruction.Case Presentation: We report the case of a 71-year-old male, chronic smoker (40 pack-years), with a one-year history of a progressively enlarging right inguinoscrotal hernia. The hernia became irreducible and painful 24 hours prior to admission, without cessation of flatus or stool and without bowel transit disturbance. On examination, the patient was hemodynamically stable and afebrile. Abdominal examination revealed a painful, irreducible, non-expansile right inguinoscrotal hernia without inflammatory skin changes. Emergency surgery revealed a small amount of reactive peritoneal fluid and necrosis of the mid-transverse colon after reduction of the hernia contents. A segmental transverse colectomy with resection of necrotic greater omentum was performed, followed by a diverting transverse colostomy (Bouilly–Wolkman procedure). Hernia repair was completed using the Bassini technique. The remainder of intra-abdominal exploration was unremarkable.Conclusion: Strangulated inguinoscrotal hernia may occur without classical obstructive symptoms. Early surgical exploration remains mandatory in irreducible painful hernias, even in the absence of bowel obstruction signs, to prevent catastrophic complications such as colonic necrosis.