PDF(Pubmed)
Abstract：
BACKGROUND: Indirect inguinal hernia and sigmoid colon cancer are both common diseases, but carcinoma within the hernia sac is rare. We present a case of sigmoid colon cancer masquerading as a right incarcerated inguinal hernia. Since such a presentation is rare, and the correct diagnosis is usually made intraoperatively, there is still no consensus on the best treatment modality for such patients.
METHODS: A 70-year-old man presented to our hospital on September 20, 2020, with a right inguinal mass that had been painful for half a month, accompanied by symptoms of difficult defecation. The bulge was originally found at least 60 years before admission. There was no pain at the time; however, the mass enlarged progressively during the last 3 years. The right scrotum and groin area were obviously enlarged (~20 × 20 cm) and tender. Inside the scrotum, a circumscribed medium-hard mass (diameter 5 cm) that was palpable, with ill-defined borders and translational mobility was detected. The computed tomography (CT) scan showed a right blood vessel-containing strangulated inguinal hernia; the sigmoid colon showed focal wall thickening as it was in proximity to the inguinal hernia. Based on the biopsy results, a pathologic diagnosis of high-grade intraepithelial neoplasia was made. The preliminary diagnosis was that of sigmoid carcinoma and right incarcerated inguinal hernia. Emergency laparoscopic exploration, open sigmoid radical resection andright inguinal hernia repair were performed under general anesthesia. The patient recovered successfully and was discharged 1 week after the operation. One month after surgery, no discomfort and signs of recurrence were found.
CONCLUSIONS: The combination of colorectal cancer and inguinal hernia is uncommon, and detailed preoperative physical examination and imaging studies may contribute to the establishment of a correct diagnosis. The selection of appropriate surgical methods ensures good therapeutic results.
METHODS: A 70-year-old man presented to our hospital on September 20, 2020, with a right inguinal mass that had been painful for half a month, accompanied by symptoms of difficult defecation. The bulge was originally found at least 60 years before admission. There was no pain at the time; however, the mass enlarged progressively during the last 3 years. The right scrotum and groin area were obviously enlarged (~20 × 20 cm) and tender. Inside the scrotum, a circumscribed medium-hard mass (diameter 5 cm) that was palpable, with ill-defined borders and translational mobility was detected. The computed tomography (CT) scan showed a right blood vessel-containing strangulated inguinal hernia; the sigmoid colon showed focal wall thickening as it was in proximity to the inguinal hernia. Based on the biopsy results, a pathologic diagnosis of high-grade intraepithelial neoplasia was made. The preliminary diagnosis was that of sigmoid carcinoma and right incarcerated inguinal hernia. Emergency laparoscopic exploration, open sigmoid radical resection andright inguinal hernia repair were performed under general anesthesia. The patient recovered successfully and was discharged 1 week after the operation. One month after surgery, no discomfort and signs of recurrence were found.
CONCLUSIONS: The combination of colorectal cancer and inguinal hernia is uncommon, and detailed preoperative physical examination and imaging studies may contribute to the establishment of a correct diagnosis. The selection of appropriate surgical methods ensures good therapeutic results.
摘要：
背景：腹股沟斜疝和乙状结肠癌都是常见病，但疝囊内的癌很少见.我们介绍了一例伪装成右嵌顿腹股沟疝的乙状结肠癌。因为这样的演讲很少见，正确的诊断通常在术中做出，对于此类患者的最佳治疗方式仍未达成共识。
方法：一名70岁的男子于2020年9月20日到我院就诊，右侧腹股沟肿块疼痛半个月，伴有排便困难的症状。该凸起最初是在入院前至少60年发现的。当时没有疼痛；然而，在过去的3年里，质量逐渐扩大。右侧阴囊及腹股沟区明显肿大(~20×20cm),触痛。在阴囊里,可触及的限定的中硬肿块（直径5厘米），边界不明确，并检测到翻译移动性。计算机断层扫描（CT）扫描显示右血管阻塞的腹股沟疝；乙状结肠在腹股沟疝附近显示局灶性壁增厚。根据活检结果,病理诊断为高级别上皮内瘤变.初步诊断为乙状结肠癌和右嵌顿腹股沟疝。急诊腹腔镜探查术,全麻下行开腹乙状结肠根治术和右腹股沟疝修补术。患者康复成功，术后1周出院。手术后一个月,没有发现不适和复发迹象。
结论：结直肠癌和腹股沟疝的组合并不常见，详细的术前体格检查和影像学检查可能有助于建立正确的诊断。选择合适的手术方法可确保良好的治疗效果。
方法：一名70岁的男子于2020年9月20日到我院就诊，右侧腹股沟肿块疼痛半个月，伴有排便困难的症状。该凸起最初是在入院前至少60年发现的。当时没有疼痛；然而，在过去的3年里，质量逐渐扩大。右侧阴囊及腹股沟区明显肿大(~20×20cm),触痛。在阴囊里,可触及的限定的中硬肿块（直径5厘米），边界不明确，并检测到翻译移动性。计算机断层扫描（CT）扫描显示右血管阻塞的腹股沟疝；乙状结肠在腹股沟疝附近显示局灶性壁增厚。根据活检结果,病理诊断为高级别上皮内瘤变.初步诊断为乙状结肠癌和右嵌顿腹股沟疝。急诊腹腔镜探查术,全麻下行开腹乙状结肠根治术和右腹股沟疝修补术。患者康复成功，术后1周出院。手术后一个月,没有发现不适和复发迹象。
结论：结直肠癌和腹股沟疝的组合并不常见，详细的术前体格检查和影像学检查可能有助于建立正确的诊断。选择合适的手术方法可确保良好的治疗效果。
