Critical Considerations in Emergency Repair of Giant Bilateral Inguinoscrotal Hernias

Abstract

This article examines the emergency surgical management of giant bilateral inguinoscrotal hernias through a representative case report. In this case, surgical intervention was required due to an associated cecal volvulus. While acute complications such as bowel strangulation are rare in hernias of this size, delayed presentation and the lack of timely surgical consultation permit significant inguinoscrotal hernia growth. Furthermore, underlying medical comorbidities in these patients may preclude the safe administration of general anesthesia, further hindering timely surgical repair. In developed countries, both trainees and consultants often have limited exposure to such cases, resulting in minimal experience managing the technical challenges involved. Key factors for successful surgical repair include addressing the loss of domain and managing extensive bilateral anatomical defects. This case report outlines the acute management of a cecal volvulus and the use of an open Rives-Stoppa repair, a technique commonly employed for recurrent, large, or complex inguinal and ventral hernias. By detailing our surgical approach and relevant surgical considerations, this case report provides an educational opportunity to understand the critical challenges of managing giant inguinoscrotal hernias.