Case report
Inguinal Canal Metastasis in a Case of Cholangiocarcinoma: A Case Report
PD01-PD03
Correspondence
Dr. Bhupendra Mehra,
205, Department of General Surgery, AIIMS - OPD, Nagpur-441108, Maharashtra, India.
E-mail: drbmehra@aiimsnagpur.edu.in
In adults, inguinal hernias are commonly encountered, and in rare instances, metastatic masses may develop within the hernia sac. Here, the authors report the case of a 75-year-old male who presented with a two-month history of jaundice, pruritus, and dark urine, along with a one-month history of right inguinal swelling. He had a prior history of bilateral inguinal hernioplasty performed 15 years earlier. On examination, the patient had abdominal distension with ascites and a 3×3 cm non-reducible right inguinal swelling without a cough impulse. Contrast-Enhanced Computed Tomography (CECT) of the abdomen revealed ill-defined, minimally enhancing lesions involving the Common Bile Duct (CBD) and Common Hepatic Duct (CHD), resulting in Intrahepatic Biliary Radical Dilatation (IHBRD) and metastatic lymphadenopathy, suggestive of Type IV cholangiocarcinoma. Additionally, an irregular, thick-walled, heterogeneously enhancing lesion measuring 3×3 cm was noted within the hernia sac, suggestive of a metastatic deposit. Imaging and histopathological evaluation of the hernia sac lesion were performed to establish the diagnosis and guide management. The patient was subsequently managed with palliative chemotherapy; however, the prognosis remained poor due to advanced metastatic cholangiocarcinoma. The present case is noteworthy as it represents a rare presentation of cholangiocarcinoma metastasising to the inguinal canal through a hernia sac-a phenomenon scarcely documented in medical literature. It highlights the importance of maintaining a high index of suspicion and performing histopathological evaluation of atypical hernia sac contents, particularly in patients with underlying malignancy.