Scholarly Article
Mechanical small bowel obstruction secondary to acute cholecystitis in the context of an irreducible inguinal hernia: A case report
Sgro, Alessandro, McIntyre, Joshua, Luhmann, Andreas
2025-07-31 · Impact Surgery · Impact Health Publishing Group
Abstract
Introduction: Small bowel obstruction most often results from adhesions, hernias or neoplasia, yet obstruction due to gallbladder perforation remains exceptionally rare. We describe a case in which dual pathology, where a seemingly straightforward incarcerated inguinal hernia and a perforated gallbladder with abscess formation, produced misleading clinical and imaging findings, delaying definitive diagnosis. Case Report: A 78-year-old man presented with 24 hours of diffuse abdominal pain, vomiting and distension, following ten days of constipation. His history included atrial fibrillation on edoxaban, severe mitral regurgitation, pulmonary hypertension, right heart failure and hypertension; he had no prior abdominal surgery. Examination revealed a distended abdomen, right upper quadrant tenderness and an irreducible right inguinal hernia. Laboratory tests showed leukocytosis (24.6×10⁹/L), elevated C-reactive protein (311.8 mg/L) and acute kidney injury (creatinine 232 µmol/L; eGFR 24 mL/min/1.73 m²). Radiography confirmed small bowel obstruction. Contrast-enhanced CT demonstrated an incarcerated inguinal hernia causing obstruction and noted a small fluid collection beside the hepatic flexure with gallbladder distension, initially deemed insignificant. Following resuscitation, antibiotics and anticoagulation reversal, laparotomy revealed a perforated gallbladder with subhepatic abscess, entrapping omentum and small bowel. The abscess was drained, subtotal cholecystectomy performed and hernia repaired without mesh. Postoperatively, he required vasopressors but recovered to ward level by day four and was discharged on day twelve. Discussion: This case underscores the need for broad differential diagnosis and vigilant radiological review when dual pathology exists. Early recognition of gallbladder perforation may permit more focused intervention, reducing operative morbidity.
Keywords
bowel obstruction, cholecystitis, abscess
Citation Details
Impact Surgery, No. 11, pp. 179-180