Surgical images: Soft tissue obstructing colon carcinoma in an irreducible scrotal hernia.

guinal hernia, present for 15 years was seen in the emergency room because the hernia had become much larger in the preceding months. In addition, he had symptoms consistent with an incomplete bowel obstruction. Physical examination revealed a very large irreducible left inguinal hernia that had descended into the scrotum down to the level of the patient’s mid-thigh. It contained bowel, and the sac was moderately tense but without evidence of strangulation. A plain radiograph of the lower abdomen and pelvis (Fig. 1) revealed a long, distended loop of colon in the left scrotal hernia. He was admitted to hospital, and bowel preparation was begun in the expectation that some of the contents of the hernia might need to be resected because of loss of their right of domain in the abdominal cavity. The bowel preparation was only partially effective, however, and produced cramping and distension of the hernia and abdomen. Through a left inguinal incision, a huge hernial sac was delivered from Continuing medical education Formation médicale continue