Inguinal Hernia with Colon in Scrotum

Inguinal Hernia with Colon in Scrotum

• Air is present in the soft tissues inferior to the right ischium.
• Close inspection of a more detailed film , reveals the air to form a loop which extends from the right pubic bone and loops back over an enlarged scrotum.
• Findings can be confirmed with contrast studies, in this case, a barium enema examination.

The combination of radiographic findings is most compatible with herniation of colon into the scrotum causing scrotal enlargement.

• The presence of air in an enlarged scrotum, is obviously a subtle finding that will only be made if the entire abdominal film is inspected.
  • It is easy to miss abnormalities on an abdominal film if they lie outside of the abdominal cavity.
    • Lung bases, soft tissues, and bones must all be routinely inspected.
  • An appropriate clinical history will be most helpful in directing the radiologist to the area of concern.
    • Don't always count on receiving good clinical information.

• It is important not only to detect abnormal air collections, but also to evaluate their pattern.
  • In this case, the loop pattern with soft tissue density in between pockets of air, resembles bowel.
    • The accompanying messentry is much more difficult to detect.

• If one does not detect the bowel gas pattern, then the differential diagnosis must be expanding to include abscess, trauma, etc.

• Among the many types of intestinal hernias --
  • Diaghragmatic hernias, including
    • Hiatal
    • Para-esophageal
    • Foramen of Bochdalek
    • Foramen of Mogagni
  • Internal, including
    • Para-duodenal
    • Lesser sac
    • Various messenteric
  • External, including
    • Inguinal
    • Femoral
    • Obturator
    • Umbilical
    • Ventral
    • Incisional
    • Omphalocele
    • Spigelian
• The reason for hernias are many and include those due to
  • Congenital abnormalities.
  • Increased intra-abdominal pressure.
  • Trauma.
  • Iatrogenic
• Complications include
  • Obstruction.
  • Strangulation.
  • Mass effect and compromise of other organs.
• DDX:
  • Other sources of abnormal air collections.
  • Other reasons for obstruction.
• Rx:
  • Surgical

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