GIANT STRANGULATED NEGLECTED INGUINAL HERNIA; IS ORCHIDECTOMY STILL NEEDED?

Aim: Giant inguinal hernia is a rare presentation; it is challenging issue for both physician and surgeons, especially if it is strangulated and neglected. In such circumstances it needs a special management and judicious surgical interference with major gut resection, in addition to orchidectomy to perform obliteration repair of inguinal canal in such infected field. Case presentation: An old blind male 60 years age presented to the casualty department Assuit university hospitals complaining of two weeks history of intestinal obstruction symptoms on top of a longstanding giant inguinal hernia that was progressing since 20 years. Examination revealed neglected strangulation of It. inguinal hernia in a high risk patient, with patches of scrotal skin gangrene. Urgent preparation and control of the risk factors was done, followed by surgical interference through inguino-scrotal and abdominal incisions for resection anastomosis of the strangulated intestine, Lt. Orchidectomy, and obliteration repair of the Lt. inguinal canal. Gangrenous infected scrotal skin was resected prior delayed primary closure. Conclusion: In spite of the advancement of medical care and hospitals, still neglected cases may be seen in surprisingly huge sizes, usually complicated, that needs a special care and wise decision especially if associated with other risks. Unilateral orchidectomy still may be a solution in such old feeble patient, with infected surgical field, with obliteration repair of inguinal canal