The hernia’s hidden passenger: strangulated epiploic appendages within a left inguinal hernia sac – a case report

Devajit C. Shyam; Ranjit C. Shyam

doi:10.18203/2349-2902.isj20263359

Authors

Devajit C. Shyam Department of General surgery, Specialist, Aster Cedars Hospital, Jabel Ali, Dubai, UAE
Ranjit C. Shyam Department of General Surgery, Nagaon Medical College, Nagaon, Assam, India

DOI:

https://doi.org/10.18203/2349-2902.isj20263359

Keywords:

Epiploic appendages, Inguinal hernia, Strangulation, Laparoscopy, Minimally invasive surgery

Abstract

Epiploic appendagitis is a rare, self-limiting inflammatory condition involving fat-filled appendages attached to the colon. Its presentation can mimic other causes of acute abdomen, making diagnosis challenging. A 38-year-old man presented with a painful, irreducible left groin swelling clinically and ultrasonographically suggestive of an incarcerated inguinal hernia. Diagnostic laparoscopy revealed two sigmoid epiploic appendages within the hernia sac, one of which was necrotic; laparoscopic reduction, TAPP mesh repair, and appendage excision were performed successfully, with an uneventful recovery and no recurrence or mesh-related complications. Although conservative treatment is often sufficient for epiploic appendagitis, the use of mesh in cases associated with strangulated inguinal hernia remains debatable. Laparoscopic approaches provide effective management with favorable outcomes, but further research is required to establish standardized treatment protocols.

Author Biography

Ranjit C. Shyam, Department of General Surgery, Nagaon Medical College, Nagaon, Assam, India

Professor ( DACP)

Department of general Surgery

Nagaon Medical college and Hospital

Nagaon, Assam, India

References

Giambelluca D, Cannella R, Caruana G, Salvaggio L, Grassedonio E, Galia M, et al. CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain. Insights Imaging. 2019;10(1):26.

Giannis D, Matenoglou E, Sidiropoulou MS, Papalampros A, Schmitz R, Felekouras E, et al. Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker. Ann Transl Med. 2019;7(24):814.

Clement Z. Atypical presentations of epiploic appendagitis: early diagnosis and non-operative management is the optimal therapy. Gastroenterol Res. 2012;5(2):79-81.

Lahham EE, Alsalah QA, Alsahouri MI, Ghweir A, AlQadi M, Sarhan N. A rare case of epiploic appendages infarction within an incisional hernia: a usual complain of unusual cause. J Surg Case Rep. 2023;2023(8):rjad483.

Sand M, Gelos M, Bechara FG, Sand D, Wiese TH, Steinstraesser L, et al. Epiploic appendagitis--clinical characteristics of an uncommon surgical diagnosis. BMC Surg. 2007;7:11.

Shiryajev YN, Glebova AV, Chalenko MV. Strangulation and necrosis of an epiploic appendage of the sigmoid colon in a right inguinal hernia. Case Rep Surg. 2013;2013:890234.

Abbasov A, Yanar HT. Incarcerated appendix epiploica in a right inguinal hernia sac. Ulus Travma Acil Cerrahi Derg. 2022;28(12):1744-6.

Husain N, Bhatia V, Rahman M. Epiploic appendagitis in an incarcerated inguinal hernia: a case report and literature review. Cureus. 2022;14(1):e21139.

Yildiz A. Incarcerated appendix epiploica in inguinal hernia sac: treatment with laparoscopic TAPP approach—report of a rare case. Case Rep Surg. 2020;2020:4178523.

McArthur D, McArthur C. Epiploic appendagitis in a femoral hernia. J Radiol Case Rep. 2019;13(5):10-4.

Jain M, Khanna S, Sen B, Tantia O. Irreducible inguinal hernia with appendices epiploicae in the sac. J Minim Access Surg. 2008;4(3):85-7.

Qudsiya Z, Lerner D. Acute epiploic appendagitis: an overlooked cause of acute abdominal pain. Cureus. 2020;12(9):e10715.

Papamichail S, Karlafti E, Malliou P, Zatagias A, Ioannidis A, Netta S, et al. A rare case of a direct incarcerated inguinal hernia containing an epiploic appendage and a literature review. Sultan Qaboos Univ Med J. 2023;23(4):547-50.

Akubudike JE, Egigba OF, Kobalava B. Epiploic appendagitis: a commonly overlooked differential of acute abdominal pain. Cureus. 2021;13(1):e12807.

Chióng Neto FV, de Paula RL, Villalaz EDS, Cruz DADS, Guimarães LSC. Epiploic appendagitis in a Spiegel hernia: a case report and review of the literature. Int J Surg Case Rep. 2021;88:106504.

Deeba S, Purkayastha S, Paraskevas P, Athanasiou T, Darzi A, Zacharakis E. Laparoscopic approach to incarcerated and strangulated inguinal hernias. JSLS. 2009;13(3):327-31.

Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Kawano Y, Kuriyama S, et al. Laparoscopic transabdominal preperitoneal repair for strangulated inguinal hernia. Asian J Endosc Surg. 2018;11(2):155-9.

Liu J, Shen Y, Nie Y, Zhao X, Wang F, Chen J. If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia? World J Emerg Surg. 2021;16(1):5.

Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc. 2011;25(9):2773-843.

Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080.

Farrell MS, Zhang Z, Kirsch J, Bower K, Bower C, Gelbard R, et al. Surgical management of incarcerated and strangulated inguinal hernias requiring urgent surgical intervention: a systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2025;99(5):795-803.