A 53-year-old homeless man, with a history of schizoaffective disorder and a long-standing history of a left inguinal hernia, which he noticed 16 years ago, was admitted to our hospital for the management of his enlarging hernia. Except for difficulties with walking and micturition and occasional urinary incontinence, he denied pain or other symptoms. The patient had declined surgical evaluation or intervention in the past. On physical examination, he was a morbidly obese male, with a nonreducible, nontender 60 X 30-cm inguinal hernia extending to the knees, with a significant dependent edema with associated skin changes (Figure 1). A computed tomography of the abdomen and pelvis revealed complete dislocation of most of the loops of small bowel and colon into the scrotum and into the hernia sac. The left ureter was embedded in the hernia sac causing left-sided hydronephrosis (Figure 2; hydronephrosis is marked with asterisk). Extensive preoperative cardiac and pulmonary assessments placed him at high risk for surgery.
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机译：一名53岁的无家可归者，患有分裂情感障碍病史，并且长期存在左腹股沟疝的病史，他在16年前就注意到了这一病，他被送入我院治疗其不断扩大的疝气。除了行走和排尿困难以及偶尔的尿失禁外，他否认疼痛或其他症状。该患者过去拒绝手术评估或干预。体格检查时，他是病态肥胖的男性，不可还原，不嫩的60 X 30厘米腹股沟疝延伸到膝盖，伴有明显的相关性水肿，伴有皮肤变化（图1）。腹部和骨盆的计算机断层扫描显示，小肠和结肠的大部分the环完全脱位进入阴囊和疝囊。左输尿管嵌在疝囊中，导致左侧肾积水（图2;肾积水标有星号）。广泛的术前心脏和肺部评估使他处于手术的高风险中。
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