ACUTE ABDOMEN CHALLENGE: PERFORATED SIGMOID DIVERTICULITIS WITHIN A STRANGULATED INGUINAL HERNIA

Objectives: Abstract: We present a rare case of perforated diverticulitis within an inguinal hernia sac adjacent to a ventral hernia that was previously repaired with mesh. An 80-year-old female presented to the ED with abdominal pain, nausea and vomiting. CT imaging was significant for a large right inguinal hernia containing a loop of bowel, adjacent to a recurrent ventral hernia previously repaired with synthetic mesh, and evidence of an early small bowel obstruction without a transition point. On physical exam, the patient had palpable bilateral inguinal hernias that were reducible on admission, however 48 hours of non-operative management she failed to progress. Repeat CT imaging was concerning for high grade SBO with a transition point in the RLQ, within the hernia sac, as well as development of new free fluid. She was taken to the operating room for exploratory laparotomy, extensive adhesiolysis, the right inguinal hernia sac contained sigmoid colon with diverticular perforation. A small bowel resection, right hemicolectomy and Hartmann’s procedure were performed. The right inguinal hernia and ventral hernias were repaired primarily, and the fascia was closed with absorbable suture in addition to retention sutures. The previously placed synthetic mesh was not grossly contaminated during this operation and therefore was not removed prior to closure. Her hospital course was otherwise unremarkable however prolonged by patient’s deconditioned state. She was discharged to a long-term assisted care facility on hospital day 42

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