engleski

From simplex to complex – a case report of incidental peritoneal carcinomatosis during hernia repair

Introduction: Inguinal hernia is an extremely rare initial manifestation of gastrointestinal tumors. It is hypothesized that it is caused by increased intraabdominal pressure from malignancies. Hernia sac peritoneal carcinomatosis (PC) suggests advanced disease and decreased life expectancy. We herein report a case of a 43-years-old male with incidental malignancy finding during hernioplasty. Materials and methods: The patient's medical record, operative reports, radiology, and pathology were reviewed. Case Description: In January 2017, an otherwise healthy patient with a left-sided inguinoscrotal hernia was scheduled in the Day surgery department for hernioplasty. Intraoperatively, hernia sac indurate was found. The hernia sac was opened, the biopsy was taken, 1, 5 l of serous fluid was evacuated, and PC was found. Postoperatively, after discovering the intraoperative findings, the patient admitted the diagnosis of ulcerative colitis untreated for the past 15 years. Computed tomography (CT) of the thorax, abdomen, and pelvis revealed the primary malignancy in the sigmoid colon infiltrating the pericolonic adipous tissue, thickening of the terminal ileum and ascending colon, and PC. The pathohistological diagnosis was adenocarcinoma. On the 7th postoperative day, explorative laparotomy revealed complete carcinosis of the small and large bowel, without the possibility of stoma formation. Due to poor general condition, chemotherapy was contraindicated. After five months, his condition progressively deteriorated with the lethal result. Conclusions: Malignancies are unexpected findings during hernia repair that significantly alter the clinical course with an incidence of less than 0.4 %. Some authors recommend the histopathology of all hernia sacs, even if there is no macroscopic abnormality to detect incidental metastases.

peritoneal carcinomatosis ; hernioplasty ; adenocarcinoma

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