Pancreas and duodenum herniation in a giant inguinal hernia sac in a patient with severe scoliosis: a rare case report

Gelevski, Radomir; Jota, GJorgji; Trajkovski, GJorgji; Nikolovski, Andrej; Andreevski, Vladimir; Deriban, GJorgji

doi:10.1093/jscr/rjaf471

Pancreas and duodenum herniation in a giant inguinal hernia sac in a patient with severe scoliosis: a rare case report

Journal

Journal of surgical case reports

Date Issued

2025-07

Author(s)

Gelevski, Radomir

DOI

10.1093/jscr/rjaf471

Abstract

Giant inguinal hernias (GIHs) are rare clinical entities, typically containing omentum or small bowel. Involvement of retroperitoneal organs, such as the pancreas and duodenum, is exceedingly uncommon due to their fixed anatomical positions. We report a unique case of a 52-year-old male with a longstanding right GIH and severe scoliosis, in whom preoperative imaging and surgical exploration revealed herniation of the pancreatic head and duodenum into the hernia sac. Contributing factors included altered retroperitoneal geometry from spinal curvature, reduced abdominal wall tone, and congenital right hip displacement with associated functional limitation. Incidental findings of multiple left hepatic duct calculi raised concerns for biliary stasis due to chronic duodenal displacement. This case highlights the importance of considering atypical hernia content in patients with longstanding hernias and complex musculoskeletal deformities, and underscores the role of comprehensive imaging and multidisciplinary assessment in surgical planning.