Publication:

The hernia’s hidden passenger: strangulated epiploic appendages within a left inguinal hernia sac – a case report

Epiploic appendagitis is a rare, self-limiting inflammatory condition involving fat-filled appendages attached to the colon. Its presentation can mimic other causes of acute abdomen, making diagnosis challenging. A 38-year-old man presented with a painful, irreducible left groin swelling clinically and ultrasonographically suggestive of an incarcerated inguinal hernia. Diagnostic laparoscopy revealed two sigmoid epiploic appendages within the hernia sac, one of which was necrotic; laparoscopic reduction, TAPP mesh repair, and appendage excision were performed successfully, with an uneventful recovery and no recurrence or mesh-related complications. Although conservative treatment is often sufficient for epiploic appendagitis, the use of mesh in cases associated with strangulated inguinal hernia remains debatable. Laparoscopic approaches provide effective management with favorable outcomes, but further research is required to establish standardized treatment protocols.