Strangulated Sliding Inguinoscrotal Hernia with a Gangrenous Bladder and Ileum.

An inguinal bladder hernia (IBH) is a common ailment in males above 50 years of age, with serious consequences of strangulation, if neglected. It is highly uncommon to have a strangulated inguinal hernia and bladder gangrene. This case reports a strangulated sliding inguinoscrotal hernia with a gangrenous bladder and ileum. We present a case of a 75-year-old man, presenting to the emergency room, with complaints of abdominal pain, distension, and absolute constipation. Examination revealed a large, firm, tender left-sided irreducible inguinal hernia. X-ray showed small bowel obstruction. Intraoperatively, a hernia sac was found with a gangrenous ileum as a slider along with a gangrenous fundus of the urinary bladder. Gangrenous segments were removed, and herniorrhaphy and bladder wall defect repair were performed. Even though a bladder can be involved in inguinal hernias, it is very rarely diagnosed preoperatively. In our case, there were no urinary symptoms, and the symptoms of strangulation outweighed bladder involvement. In any elderly patient with a giant hernia, a bladder entrapment should be ruled out with a strong index of suspicion. Failure to do so may result in complications after surgery. Hence, we conclude that it is better if all patients with long-standing giant hernias have a computed tomography (CT) prior to surgery.

Syndrome Valentino From a De Novo Aetiology - Acute Pancreatitis.

Valentino syndrome is one of the rare classical presentations of duodenal perforation, wherein the leaked contents collect at the right lower quadrant of the abdomen causing local peritonitis and mimicking appendicitis. Here we present a case profile of a 28-year-old gentleman, who presented with right lower quadrant abdominal pain and mass, which was clinically diagnosed as acute appendicular inflammatory mass. Later with laboratory reports and radiological imaging, he was confirmed to have acute pancreatitis, and actually the peripancreatic fluid collection has tracked down into the right iliac fossa and pelvis to present similar to Valentino syndrome. This article is reported to highlight acute pancreatitis as a cause of Valentino syndrome.