Case Report: Strangulated transverse colon inguinal hernia complicated by cecal perforation in a patient with sclerosing mesenteritis.

BACKGROUND

Transverse colon herniation into the inguinal canal is exceptionally rare. The transverse colon, being entirely intraperitoneal and suspended by the transverse mesocolon, is anatomically resistant to inferior displacement. Few cases of transverse colon herniation into inguinal or femoral hernias are documented, most occurring in the presence of giant hernia defects, malignancy, or concurrent omental herniation. We report an unusual case of isolated transverse colon strangulation within a right inguinal hernia in the setting of sclerosing mesenteritis (SM), suggesting a novel pathological mechanism for this rare clinical entity.

CASE PRESENTATION: A 58-year-old man presented with acute abdominal pain and an irreducible right groin mass. Computed tomography demonstrated the transverse colon herniated into the right inguinal canal, cecal dilatation, and pneumoperitoneum. Emergency laparotomy revealed a necrotic transverse colon, a perforated cecum, and fibrotic mesenteric plaques with mesenteric shortening. The patient underwent right hemicolectomy, protective loop ileostomy, and Bassini herniorrhaphy. Histopathology confirmed mesenteric fibrosis without evidence of malignancy. The postoperative course was uneventful, and ileostomy closure was performed three months later.

CONCLUSION

We propose that mesenteric shortening secondary to sclerosing mesenteritis displaced the transverse colon inferiorly, facilitating its herniation through a pre-existing inguinal defect. This potential association suggests that mesenteric fibroinflammatory disease may warrant consideration when encountering atypical hernia contents.