Diagnosis of an Inguinal Hernia after a Blunt Inguinal Trauma with an Intestinal Perforation

Introduction. Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia. Case Report. We present a case of a 45-year-old Eastern European man with a small perforation of ileal bowels and a peritonitis after direct blunt trauma to the inguinal hernia region, with no inguinal hernia known by the patient, and show how the diagnosis can be difficult. Conclusion. This case shows that external forces, that may seem too trivial to cause intraperitoneal injury, can cause significant injury when applied to a patient with a hernia and shows how a careful examination, with the help of an abdominal CT scan, is important even if the patient do not seem to have an inguinal hernia. 1. Introduction Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. Treatment is often a surgical intervention because of the risk of intestinal incarceration and strangulation. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia [1–5]. This case report emphasizes the difficult diagnosis and the potential clinical complication of an unknown inguinal hernia if a blunt trauma occurs in the inguinal area. 2. Case Presentation During a handball match, a 45-year-old Eastern European man with a medical history of appendicectomy and no inguinal hernia known suffered trauma from another player’s knee onto the right inguinal area. After this trauma, he presented a collapse for few seconds and developed intense pain in the hypogastrium. He was immediately taken by the emergency medical service and transferred to the Emergency Department, where he has the following vital signs: heart rate 90？beats/min, blood pressure 104/61？mmHg, and temperature 37°C. Abdominal examination revealed diffuse pain, absence of intestinal sounds, and involuntary muscular resistance but no inguinal hernia. Laboratory tests showed a hematocrit of 46.5%, leukocytes 6730/mm 3, serum creatinine 89？ mol/L, and blood urea nitrogen 8.5？mmol/L. Ultrasounds showed no fluid in the peritoneal cavity. So an abdominal CT scan with intravenous contrast was