Ischemic colitis of left side colon in an incarcerated – Retracted left inguinal hernia, resulting in septic shock and multiple organ failure

Abstract text (incl. references and figure legends)
Case history

Patient, male, 74 years old, came to the Emergency Department, reporting acute abdominal pain that began 3 days ago after a forced reduction of left inguinal hernia that was performed in another Hospital. Accompanying symptoms are diarrheal stools and reduced diuresis. From his history he referred coronary disease, arterial hypertension, hyperlipidemia, hyperuricemia.

Clinical Findings

The patient looked sick and had acute abdomen. The 4th day appeared bloody diarrhea with hemodynamic destabilization.

Investigation/Results

Laboratory blood test was performed. The 1st CT scan was carried out and showed mild smooth rectosigmoid wall thickening with opacification of the mesocolon, increased vascularity and small left inguinal hernia with fat content. A follow-up CT scan and sigmoidoscopy were performed, where ischemic colitis was found at 30 cm of sigmoid colon.

Diagnosis

Diagnosis of septic shock, caused by ischemic colitis as a result of the forceful retraction of the sigmoid colon as it was content of the inguinal hernia. Additionally acute renal failure with hepatic impairment was established.

Therapy and Progressions

He underwent an emergency laparotomy, Hartmann" s sigmoidectomy with end colostomy under general anesthesia. He was hospitalized in the intensive care unit postoperatively. Hemodialysis sessions and thoracic puncture were required to treat renal failure and postoperative pleural effusion. He was hospitalized for a month and returned after 9 months for reversal surgery.

Comments

Ιnguinal hernia retraction is often attempted, however it appears that significant complications may occur.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805903/

https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/facts-about-ischemic-colitis

https://pubmed.ncbi.nlm.nih.gov/30689076/

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