Iatrogenic enterocutaneous fistula following a misguided surgical procedure in Torit, South Sudan

Abstract

Groin hernia is common among active people in sub Saharan Africa. It contributes significantly to morbidity and mortality because of its unusual sac content. Various organs can be unexpectedly found in the sac when performing hernia repair surgery. Presence of the caecum in the sac is very uncommon. Enterocutaneous Fistula [ECF] is the worst complication that could occur following groin hernia surgery. We report a rare case of  iatrogenic ECF following an incarcerated right inguinal hernia repair done by a traditional healer which caused a cecostomy and subsequent ECF. A 50-year-old lady presented with ECF two weeks after undergoing right inguinal hernia repair. Clinically, and with an aid of abdominal sonogram, a diagnosis of ECF was made. She was successfully treated by caecectomy and primary repair, appendectomy, local debridement of the fistula site and Bassini’s repair of the right inguinal hernia. In cases like this every effort should be made to preserve the organ found in the hernia sac to ensure an uneventful postoperative period. ECF treatment depends on the type, site, and nature of the fistula.

Key words: groin hernia, inguinal hernia, enterocutaneous fistula, caecum
injury.