A rare encounter of obstructed direct inguinal hernia of sliding variety

Highlights • Obstructed direct inguinal hernia of sliding variety with bladder being one of its contents is extremely rare and no such case has been reported yet. • Though incarceration and even strangulation are extremely uncommon in direct inguinal hernia as compared to indirect inguinal hernia. A long standing direct inguinal hernia may present as acute or sub-acute intestinal obstruction especially in elderly patients. Hence old age with obstructed inguinal hernia might be of direct variety and needs to be repaired immediately. • Sliding hernias are diagnosed intra-operatively and is very difficult to identify clinically. Sliding hernias are most common in old age male, of indirect variety on left side according to most literatures. • The good operating technique and the use of modern prosthetic materials should allow us to have the same risk of early and late complications after operating on a sliding and non-sliding inguinal hernia.
Introduction Direct Obstructed inguinal hernias of sliding variety with bladder as its content is extremely rare. Case Report We report the case of an 83-year-old male known case of DM, presented with irreducible and painful swelling over the right inguinal region and cough impulse on right inguinal region. On exploration of the right side, the obstructed hernia was found to be a direct type sliding hernia with sac wall forming anterior covering layer and containing congested small bowel loops (ileum) and bladder forming the medial wall of the hernia sac. After gaining viability the content was reduced, posterior wall defect was closed and Lichtenstein tension free repair was done. Conclusion Direct inguinal hernia of sliding variety getting obstructed is rare. Direct Sliding hernia on right side with ileum as content and bladder forming the wall is extremely rare.