Preoperative progressive pneumoperitoneum in inguinoescrotal hernia with loss of the right of domain

Abstract

Hernia with loss of the right of domain can be defined as one in which more than 20 % of the abdominal content is found in the hernia sac. Repair, without preoperative maneuvers that increase abdominal capacity, can cause abdominal compartment syndrome. Numerous maneuvers are used to prevent this. We present the case of a 62-year-old patient, who goes to the emergency department referring that approximately 20 years ago he presents a tumor increasing in size in the right inguinal region and interests even the scrotum. After a physical effort he felt pain in the region, without changes in color or temperature, denies vomiting and has kept expelling feces and gases. Upon physical examination, the presence of a tumor in the right inguinoscrotal region, of about 30 x 40 cm, not reductable, painful, without peritoneal reaction, without changes in coloration or temperature. Hydroaerial noises in the right scrotum. Admitted with a diagnosis of right inguinoscrotal hernia with loss of right of domain. Additional preoperative examinations are indicated, Vygon intraperitoneal catheter size 18 is placed in the left iliac fossa to initiate preoperative progressive pneumoperitoneum, which fostered in the surgical act, the reintroduction of the viscera to the abdominal cavity, the hernial plasty and the favorable evolution of the patient. The use of preoperative progressive pneumoperitoneum in the presurgical treatment of inguinoscrotal hernia with loss of right to home is a safe and successful alternative.