Small Intestinal Diverticulosis with Gangrenous Perforation in a Strangulated Inguinal Hernia: Diagnostic Challenge

Abstract

Background: The clinical signs of peritonitis in patients with strangulated inguinal hernia, causing perforated small intestine diverticulosis, are often difficult to be recognized.  The clinical signs of diverticulosis can be similar or even misdiagnosed with abdominal wall hernia because the pathology of both diseases has some similarities in their mechanisms. Multiple studies indicate that connective tissue disorders might significantly contribute to the development of diverticulosis and hernias in the abdominal wall.

Case Report: A 64-year-old male presented with sudden-onset abdominal pain lasting six hours. He also reported a palpable, non-reducible mass noted in the left inguinal region, accompanied by nausea and vomiting. On physical examination, there was tenderness, rebound tenderness, and defans muscular tense in the entire abdominal region, and a non-reducible mass was palpable in the left inguinal region. Five mililiter of brown gastric fluid was obtained from the NGT tube. The results of a plain abdominal X-ray were dilatation of the small intestine and large bowel; no step ladder image, no free air was seen, and the psoas line was not visible. The diagnosis of small intestine diverticulosis with perforation was concluded during exploratory laparotomy based on indications of peritonitis.

Conclusion: The clinical signs of diverticulosis can resemble an inguinal hernia, so surgeons need to be aware of this occurrence to select the treatment and avoid post-operative worsening.