Emergency laparoscopic transabdominal preperitoneal repair of bilateral pantaloon hernia presenting with acute small bowel obstruction

ABSTRACT: Pantaloon hernia (PH) is defined as ipsilateral direct and indirect inguinal hernias. Bilateral PH is an exceedingly rare occurrence. Here, we report a case of a 73-year-old man with a painful, irreducible right groin swelling associated with vomiting and features of small bowel obstruction with bilateral groin swelling noted clinically. Contrast-enhanced computed tomography revealed an indirect hernia on the right containing obstructed small bowel and a left inguinal hernia partially containing the urinary bladder. Diagnostic laparoscopy revealed a bilateral PH with right-sided obstruction. After reducing the obstructed small bowel and checking its viability, the transabdominal pre-peritoneal approach was undertaken to repair the hernial orifices. The post-operative recovery was uneventful, and the patient was discharged on post-operative day 3. Serial follow-ups revealed no complications. This case highlights that, with experience, laparoscopic repair of bilateral PH in emergencies is safe, feasible and a practical alternative to open surgery.