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Eviscerated perforated hernia in an HIV/AIDS patient
General Surgery

Eviscerated perforated hernia in an HIV/AIDS patient

We present a 35 year old male HIV/AIDS patient on ARVs who presented to our hospital with several months duration of incarcerated left inguinoscrotal hernia . scrotal contents eviscerated whilst at home . Patient did not seek medical attention. He did not complain of any obstructive symptoms. He could feed normally but could not pass stools.

Wasted,  stable, not pale, not icteric. Chest was clear , heart sounds normal.
Abdomen was scaffoid and soft.
A pink mass measuring 10*8 cm  was seen in extruding from left hemiscrotum. Mass was discharging bilous fluid . there was no remarkable tenderness. rectal examination was unremarkable.

Eviscerated perforated bowel

Diagnosis : Eviscerated perforated left inguinoscrotal hernia
Investigations : Blood counts was essentially normal
Condition explained to patient. Decision taken to do laparotomy . Patient consented to surgery
Operative details
Findings: Caecal perforation, defect size 8cm, bilous discharge from ileocaecal valve. Viable well vascularised caecum
Anaesthesia was SAB. A median abdominal incision with scrotal extension was made to mobilise the eviscerated bowel. Edges of bowel freshened and closed primarily with single layer extramucosal interrupted sutures using vicryl 2/0. hernia repair was done . abdominal wound was closed routinely. Scrotal wound toileted, debrided and closed primarily.
Left index finger inserted into caecal lumen

Caecum in Rt hand, appendix being held by forceps

Immediate post operative period

Postoperative period: Patient recovered well. wound was clean at time of discharge . Patient discharged on post op day 5.
Dr Richard Ametih
St Benito Menni Hospital
Adansi Dompoase