Lagziel T1,2* and Mazarieb M2
1Department of General Surgery, Rabin Medical Center, Israel
2Sackler Faculty of Medicine, Tel-Aviv University, Israel
led to new operational protocols for standard surgical practice. We do not have a lot of objective information on pandemic’s effect on surgical practice. We do know, however, that a great burden is placed on global and local healthcare systems, including surgical infrastructure. We present an 89-year-old male with a history of hypertension, carotid artery stenosis, heart failure, cerebrovascular disease, chronic renal failure, and positive, asymptomatic COVID-19 and active coffee-ground emesis and fever. The patient was immediately admitted to the dedicated COVID-19 ward. Physical exam exposed a giant right-sided, irreducible inguinoscrotal hernia. On day 2, his clinical condition deteriorated with hypotension and generalized abdominal tenderness. Blood tests revealed lactic acidosis and the CT scan demonstrated a likely bowel perforation within the hernia sac. Explorative laparotomy exposed a complete herniation of the small bowel and cecum into the hernia sac without no signs of strangulation. All attempts to mobilize the bowel from the hernia sac failed and a decision was made to open the groin to try to reduce the hernia. During examination of the bowel, the cecum was found to be ischemic and perforated without fecal spillage. A right hemi colectomy with terminal ileostomy was performed. The patient was returned to the COVID-19 ward for recovery in an unstable condition. The management of surgical patients in the COVID-19 era requires expert clinical judgment. Disease manifestations may not present themselves preoperatively but may play a role in the post-operative state and this should be taken into account when planning patient treatment.
COVID-19; Inguinoscrotal hernia; Hypotension; Computed Tomography; Ileostomy;
Lagziel T, Mazarieb M. A Giant, Chronic, Irreducible Inguinoscrotal Hernia with Cecal Perforation in a Hospitalized COVID-19 Patient: A Case Report and Review of Literature. Ann Clin Surg. 2021; 2(2): 1018.