CASE REPORT Small bowel perforation due to blunt trauma directly to the inguinal region: A case report Received: 8 October 2002 / Accepted: 7 January 2003 / Published online: 16 September 2003 Ó Springer-Verlag 2003 Abstract We report on a patient with intestinal perfo- ration caused by direct blunt trauma to the inguinal region. The patient had been previously diagnosed with an inguinal hernia. The perforation was managed sur- gically, and he subsequently underwent hernia repair. In our opinion, intestinal perforation caused by inguinal region trauma in patients with inguinal hernias is a rare and unfortunate situation but one that reveals the importance of inguinal hernia repair. Keywords Inguinal hernia Æ Intestinal perforation Æ Blunt trauma Introduction A hernia can be defined as any protrusion of the abdominal contents outside the abdominal cavity through a natural or acquired defect of the abdominal wall. Inguinal hernias are the most common form of hernias, and almost 25% of men and 2% of women develop an inguinal hernia during their lifetime. The hernias are generally reducible; and although strangu- lation and incarceration are the most common compli- cations of unrepaired hernias, the reasons for these problems remain unclear. A blunt trauma to the inguinal region in a patient with inguinal trauma can cause intestinal perforation because the compression on the incoming and outcom- ing loops may increase the intraluminal pressure [1]. This is such an unusual complication that only seven patients in six reports are present in the literature [1, 2, 3, 4, 5, 6]. In this paper, we present a patient with this unfortunate and rare complication of inguinal hernia. Case report A 35-year-old white male carpenter was admitted to Kartal Edu- cation and Research Hospital 2 h after a piece of board caused blunt trauma to his right inguinal region. He had been diagnosed with a right inguinal hernia almost 5 years earlier, but he had re- fused an operative repair since then. According to his medical re- cords, during the diagnosis, the hernia was moderately large, but the content of the sac could be manually reduced into the abdomen. His abdominal exam was normal except for an abrasion over his right inguinal region. He had no abnormal laboratory findings. The patient was hospitalized for the observation of his mild abdominal pain. Six hours after his admission, abdominal tenderness and re- bound were observed during the re-examination. He also com- plained of worsening abdominal pain. His leukocyte count had risen from 7,300/mm 3 to 14,300/mm 3 . An ultrasound examination revealed free abdominal fluid in the pelvic space but did not specify the cause (Fig. 1). An exploratory laparotomy revealed a 1-cm-long perforation at the middle of a 6-cm-long edematous ileal segment. A segmental resection and an end-to-end anastomosis were performed. The abraded skin was completely over the inguinal region and was not touching abdominal cavity. The patient’s recovery was uneventful, and he was discharged on postoperative day 5. Two months after the initial operation, the patient underwent a tension-free hernia repair. Discussion The relationship between the presence of hernias and intestinal perforations due to trauma has been well documented. Vyas et al. found that traumatic intestinal perforation rates were higher in patients with inguinal hernias than in the healthy population [7]. But intestinal perforations caused by direct blunt trauma to the inguinal region have been rarely reported [1, 2, 3, 4, 5, 6]. Similarly, other traumas to the previously damaged abdominal wall (i.e., traumatic pubic symphysis diasta- sis) can cause serious injuries [8]. Hernia (2003) 7: 218–219 DOI 10.1007/s10029-003-0131-3 M. Oncel Æ N. Kurt Æ M. Eser Æ I. Bahadir M. Oncel (&) Æ N. Kurt Æ M. Eser Æ I. Bahadir Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey E-mail: mustafaoncel@hotmail.com Tel.: +1 216 445 5020 Fax: +1 216 445 8627 Present address: M. Oncel Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A30, Cleveland, OH 44195, USA