Intestinal perforation from trauma to an inguinal hernia.

Inguinal hernias are most feared to result in incarceration and strangulation of intra-abdominal structures. Blunt abdominal blows have previously been reported to cause traumatic perforation of bowel that overlays the defect of any abdominal wall hernia. To my knowledge, this case report is the first to show that bowel perforation may be caused by direct trauma to an inguinal hernia that contains a loop of small bowel. It is proposed that the force of the blow first opposes the walls of the incoming and outgoing bowel, sealing the loop. Then, additional pressure that is applied will raise the loop's intraluminal pressure to the point that traumatic perforation occurs. A simple experiment on a necropsy specimen showed that the proposed mechanism is plausible. This case points out another risk of leaving an inguinal hernia unrepaired.