Prenatal diagnosis of incarcerated inguinal hernia leading to congenital colonic stricture: A case report

Fetal inguinal hernia is a rare prenatal diagnosis, and in utero incarceration has not been previously described. A 41-year-old gravida 3 para 2 with an uncomplicated in vitro fertilization (IVF) pregnancy was referred at 34 weeks’ gestation for a fetal scrotal mass, ascites, and polyhydramnios. Serial ultrasonography demonstrated a left-sided inguinal hernia containing bowel with preserved peristalsis. At 37 weeks, cesarean delivery was performed for worsening polyhydramnios and concern for bowel obstruction. At birth, the hernia was noted to be reducible; however, the neonate developed progressive abdominal distension and signs of bowel obstruction on day of life one, prompting operative intervention. Exploratory laparotomy on day of life 1 revealed an incarcerated distal sigmoid colon with a fixed stricture and associated colonic atresia causing obstruction. Segmental resection with end colostomy was performed, and the inguinal hernia was repaired.. Histopathology demonstrated submucosal fibrosis and vascular ectasia consistent with chronic compression. Staged repair consisted of colostomy formation on day of life one followed by colostomy takedown and primary anastomosis at three months of age, with good recovery and normal bowel function on follow-up. Prenatal diagnosis of an inguinal hernia should prompt close surveillance for evolving bowel obstruction, given the risk of compression-related intestinal stricture.