P3416 - Or Maybe Don’t Push: Colonoscope Incarcerated in a Left Inguinal Hernia

Anthony Passarella, MD¹, Maithao Le, MD², Elise Malecki, MD, PhD^2
1Albany Medical College, Albany, NY; ²Stratton Veterans Affairs Medical Center, Albany, NY

Introduction: Although pushing the limits in endoscopy in a metaphorical sense is laudable, there are occasions when pushing can be problematic. Here we describe a rare complication of colonoscopy.

Case Description/Methods: In 2015, a 54 year old man with type II diabetes mellitus, obesity, and hyperlipidemia underwent a screening colonoscopy with polyps found. A year later, the patient was referred to the surgical service for a reducible and non-tender left inguinal hernia. He decided against elective repair at that time and was lost to surgical follow up. This year he presented for direct-to-endoscopy surveillance, opting for an unsedated exam. Difficulty advancing through the sigmoid colon was noted, necessitating removal of the distal cap attachment. Further difficulty was noted in the right colon, but after repositioning patient and external pressure, a sudden relative ease of advancement was noted and the cecum was reached with difficulty. Throughout, the patient did not seem to have excessive discomfort. Withdrawal of the colonoscope revealed no polyps, only moderate diverticulosis. When the end of the colonoscope reached the distal descending colon, withdrawal or advancement did not appreciably change the scope position in an appropriate 1:1 fashion and induced pain in the left groin. A loop of scope was appreciated in the left inguinal hernia; the patient when questioned stated that bowel became incarcerated in this hernia in the years between his surgical consultation and the colonoscopy. The hernia containing the looped colonoscope could not be reduced with Trendelenburg positioning or topical ice packs. The General Surgery team was consulted emergently. The patient was transferred to the operating room for left groin exploration and hernia repair. The hernia was operatively reduced and the colonoscope delivered. Mesh repair of the patient's hernia repair was accomplished. The patient was observed overnight and did well.

Discussion: Incarceration of the colonoscope in a left inguinal hernia has been described but is likely an underreported outcome. This case points out the importance of an extra thorough history and abdominal exam in direct-to-endoscopy referrals, and other lessons can be drawn from the details of the case. In retrospect, the offset position of the lumen when difficulty was first encountered was then appreciated as the entry to the inguinal hernia, and the sudden ease was likely the result of twisting of the loop within the hernia. Caution regarding this entity bears repeating.


Disclosures:


Anthony Passarella, MD¹, Maithao Le, MD², Elise Malecki, MD, PhD². P3416 - Or Maybe Don’t Push: Colonoscope Incarcerated in a Left Inguinal Hernia, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.