Colonoscope incarceration in an inguinal hernia.

A 73−year−old man who presented with symptoms of abdominal cramping and bloody stool passage underwent colonos− copy. After sedation, the procedure was carried out without difficulty, until at ap− proximately 60 cm, the colonoscope could not be advanced, although the lumen was clearly visible. Attempts to withdraw the scope failed and resulted in significant lower abdominal pain, as well as resist− ance to retrograde withdrawal. The pa− tient was moved to the fluoroscopy room. Under fluoroscopy, a loop of colo− noscope was seen in the left inguinal her− nia (Figure 1). On examining the inguinal hernia sac, it was clear that the colono− scope was incarcerated within the hernia sac. The colonoscope could not be with− drawn directly while the loop of the scope within the hernia sac was in U−shape. But after forming an alpha loop in the hernia sac, by pushing and rotating the scope combined with careful withdrawal by gentle traction, the loop could be easily pushed into the abdominal cavity from the scrotum. Thus, we successfully re− duced the incarcerated hernia. In the English literature, only four other reports describe a colonoscope incarcera− tion within a hernia sac [1± 4]. Although it is rare, the colon is at risk within an incar− cerated inguinal hernia. Careful history taking and physical examination, includ− ing the inguinal area, are important be− fore undergoing colonoscopy. Although extraction of the colonoscope was diffi− cult, the fluoroscope was an important tool in this case. We used the fluoroscope not only to estimate the width of the ori− fice of the hernia sac [2], but also to at− tempt to minimize the loop in the hernia sac. Although it could injure the fiber of the scope, we found that it was easier to minimize the loop by gently withdrawing the scope after forming an alpha loop. After the loop was minimized, the possi− bility of manual reduction could be esti− mated by comparing the size of loop with the width of the orifice of the hernia sac, under fluoroscopy. After reduction, it was possible to rotate the scope to release the alpha loop into the abdominal cavity, and withdraw it smoothly.