Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation Holmdel, NJ
Meena Kumari Bellamkonda, MBBS1, Neal Vasireddi, BA, BS2, Nikhil Vasireddi, BA, BS, MHA3, Srinivas Mendu, MD4, Sonia Deora, DO4, Srinivas S. Vasireddi, MD2 1Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Holmdel, NJ; 2Advanced Digestive Center, Inc., Metuchen, NJ; 3Case Western Reserve University Medical School, Cleveland, OH; 4Garden State Physicians, Princeton, NJ
Introduction: Screening colonoscopies are generally very safe with low risk of serious complications which include post-polypectomy bleeding (0.2%) and perforation (1%) with some varied much rarer complications . Here we present such a rare case of scrotal incarceration and small bowel obstruction after a routine screening colonoscopy procedure.
Case Description/Methods: A 45 year old male patient had a routine screening colonoscopy which revealed first degree Hemorrhoids and a small adenomatous Sigmoid colon polyp. The procedure was uneventful without any immediate complications and follow-up colonoscopy was recommended in 10 years.
The patient reported acute right testicular pain and swelling 20 hours later.He was immediately seen and sent to the hospital for further evaluation the next day.He reported some nausea without vomiting with no bowel movements post colonoscopy.He did not have any prior history of inguinal hernia.
On Physical exam, the right hemiscrotum was enlarged(10 cm wide) and obscured by large inguinal hernia.Positive bowel sounds were noted without any skin changes, warmth or open wounds. The left testicle and hemiscrotum were normal and non tender. Rest of the exam was normal.
A scrotal ultrasound,pictured here,showed an incarcerated small bowel loop. CT scan of abdomen and pelvis with contrast revealed an Incarcerated right inguinoscrotal hernia with small bowel obstruction(see image).
Surgical reduction and repair of the very large ( >20 cm) indirect right inguinal hernia with mesh was completed successfully.Recovery was uneventful and he was discharged after a two day stay.
Discussion: Our patient did not have any previous history of hernia , surgeries or any abdominal complaints prior to the colonoscopy. The scrotal small bowel herniation and incarceration after colonoscopy was a rare and unpredictable presentation. Immediate hospitalization and radiography helped to make a diagnosis and treat the patient surgically. Any delayed intervention could have caused strangulation, gangrene and necrosis of the bowel. In conclusion, scrotal incarceration and small bowel obstruction is a rare postcolonoscopy complication which should be considered in case of acute scrotal swelling and pain after colonoscopy. Excessive straining at bowel movements with the bowel preparations could have resulted in such a rare post procedural acute manifestation of previously undiagnosed asymptomatic inguinal herniation.
References:Iain A Hunter, Rupa Sarkar, Andrew M Smith, J Med Case Reports, 2008 May 27, Page 1
Figure: CT and Scrotal Ultrasound images showing the right scrotal incarceration of small bowel and bowel obstruction
Meena Kumari Bellamkonda indicated no relevant financial relationships.
Neal Vasireddi indicated no relevant financial relationships.
Nikhil Vasireddi indicated no relevant financial relationships.
Srinivas Mendu indicated no relevant financial relationships.
Sonia Deora indicated no relevant financial relationships.
Srinivas Vasireddi indicated no relevant financial relationships.
Meena Kumari Bellamkonda, MBBS1, Neal Vasireddi, BA, BS2, Nikhil Vasireddi, BA, BS, MHA3, Srinivas Mendu, MD4, Sonia Deora, DO4, Srinivas S. Vasireddi, MD2. P2003 - A Rare Case of Scrotal Incarceration and Small Bowel Obstruction as an Early Complication After Routine Colonoscopy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.