Advances in Surgical Sciences 2017; 5(5): 61-64 http://www.sciencepublishinggroup.com/j/ass doi: 10.11648/j.ass.20170505.11 ISSN: 2376-6174 (Print); ISSN: 2376-6182 (Online) Case Report Giant Inguinoscrotal Hernia: The Challenging Surgical Repair and Postoperative Management Ikhwan Sani Mohamad 1, * , Chen Yen Chuan 1 , Narendran Balasubbiah 2 , Zaidi Zakaria 1 , Syed Hassan 1 1 Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia 2 Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia Email address: ikhwansani@yahoo.com.my (I. S. Mohamad) * Corresponding author To cite this article: Ikhwan Sani Mohamad, Chen Yen Chuan, Narendran Balasubbiah, Zaidi Zakaria, Syed Hassan. Giant Inguinoscrotal Hernia: The Challenging Surgical Repair and Postoperative Management. Advances in Surgical Sciences. Vol. 5, No. 5, 2017, pp. 61-64. doi: 10.11648/j.ass.20170505.11 Received: April 8, 2017; Accepted: April 28, 2017; Published: October 23, 2017 Abstract: Inguinal hernia operations are compulsory surgical skill assessment for residence in surgical field and most centres practice day care services for such cases. Giant inguinal hernias usually occur in neglected long standing diseases and repair of these condition added challenges in term of content reduction as well as managing postoperative complications. This case was a unique case of a giant inguinal hernia which was left untreated for 40 years. The contents of the hernia which include greater omentum, small and large bowel were reduced successfully after extension of the deep inguinal ring. The patient was ventilated and paralyzed for 48 hours in view of anticipating intraabdominal hypertension. Post operatively the patient recovered well and discharged on Day 6 post operatively. Keywords: Inguinal Hernia, Deep Inguinal Ring, Intraabdominal Hypertension 1. Introduction Giant inguinal hernias are defined as the extension of hernia sac below the midpoint of the inner thigh or beyond in the standing position and are uncommonly encountered in developed countries. Nevertheless, they may still present after years of neglect with poverty, illiteracy and poor healthcare access. [1, 2, 3] 2. Case Report This is a case of a-60-year-old gentleman who had presented to the surgical clinic with right inguinoscrotal swelling for 40 years. Initially, it was only ping pong ball size at the groin region. It was spontaneously reducible and had not caused much symptoms to the patient. However, the swelling had progressively enlarged to a size of a football and irreducible for the past 9 years. It had started to cause some pain at the swelling and right lower abdomen over the past 3 months prompting the patient to seek medical attention. No symptoms of intestinal obstruction. History of lifting heavy weight earlier in his life prior retirement 4 years ago when he was a store keeper. Otherwise patient has no lower urinary tract symptoms, no constipation and no chronic cough. On examination; patient was comfortable lying supine. Patient could walk but with an open stance gait due to the large inguinoscrotal swelling pushing his both thighs to abducted position at the hip joint. There was a large right inguinoscrotal swelling which cannot get above when palpated from the scrotum, measuring 45 cm obliquely from the deep ring to the lower edge of the swelling at the scrotum. The consistency of the swelling was mostly doughy as well as granular at certain areas with visible peristalsis. (Figure 1) The patient had undergone right Lichenstein mesh hernioplasty with repair of the deep inguinal ring which had to be incised during reduction of the hernia contents into the peritoneal cavity. The hernia contents were; 1 meter length of small bowel proximal from the ileocaecal junction, caecum