{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:05:42Z","timestamp":1790892342369,"version":"4.1.0"},"reference-count":32,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,7,28]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>Giant inguinoscrotal hernias (GISHs) are rare and present unique surgical challenges. We report a case of a man in his 60s with a GISH complicated by loss of domain, with nearly two-thirds of the small bowel and right colon incarcerated in the inguinoscrotal hernia sac. A comprehensive preoperative plan was implemented, including botulinum toxin injections, placement of an inferior vena cava filter and progressive preoperative pneumoperitoneum per a locally developed protocol. A combined surgical approach was used, involving laparotomy, scrotal reconstruction, adhesiolysis, right hemicolectomy with omentectomy and Rives-Stoppa mesh repair extending into the retropubic space. A suture closure of the inguinal ligament to the pectineal line was performed with a Phasix Mesh. Plastic surgical techniques were employed to reduce scrotum size and reconstruct the penis. This case demonstrates the importance of a multimodal perioperative and surgical approach to manage GISHs to achieve optimal surgical outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-266990","type":"journal-article","created":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T07:35:33Z","timestamp":1755416133000},"page":"e266990","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Multimodal management of a giant inguinoscrotal hernia with loss of domain"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1944-5452","authenticated-orcid":false,"given":"Nadia","family":"Natasha","sequence":"first","affiliation":[{"name":"York Abdominal Wall Unit, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim","family":"Abbas","sequence":"additional","affiliation":[{"name":"York Abdominal Wall Unit, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivas","family":"Chintapatla","sequence":"additional","affiliation":[{"name":"York Abdominal Wall Unit, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Macleod","sequence":"additional","affiliation":[{"name":"York Abdominal Wall Unit, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,16]]},"reference":[{"key":"2025081700352468000_18.8.e266990.1","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.ijscr.2014.10.042","article-title":"Giant inguinal hernia: Report of a case and reviews of surgical techniques","volume":"5","author":"Trakarnsagna","year":"2014","journal-title":"Int J Surg Case Rep"},{"key":"2025081700352468000_18.8.e266990.2","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1007\/s00268-019-05317-z","article-title":"Definitions for Loss of Domain: An International Delphi Consensus of Expert Surgeons","volume":"44","author":"Parker","year":"2020","journal-title":"World J Surg"},{"key":"2025081700352468000_18.8.e266990.3","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1007\/s10029-022-02605-x","article-title":"Tanaka score predicts surgical intensive care admission following abdominal wall reconstruction","volume":"26","author":"Said","year":"2022","journal-title":"Hernia"},{"key":"2025081700352468000_18.8.e266990.4","article-title":"Risk Factors for Postoperative Complications in Hernia Repair","volume":"16","author":"Assakran","year":"2024","journal-title":"Cureus"},{"key":"2025081700352468000_18.8.e266990.5","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"2025081700352468000_18.8.e266990.6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/anae.14510","article-title":"Pre-operative optimisation of the surgical patient with diagnosed and undiagnosed diabetes: a practical review","volume":"74 Suppl 1","author":"Levy","year":"2019","journal-title":"Anaesthesia"},{"key":"2025081700352468000_18.8.e266990.7","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1080\/2000656X.2017.1285783","article-title":"Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia","volume":"51","author":"Weissler","year":"2017","journal-title":"J Plast Surg Hand Surg"},{"key":"2025081700352468000_18.8.e266990.8","first-page":"D5782","article-title":"Botox voorafgaand aan littekenbreukcorrecties [Botox preceding ventral hernia repair: it\u2019s not about esthetics]","volume":"165","author":"Timmer","year":"2021","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2025081700352468000_18.8.e266990.9","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s10029-025-03401-z","article-title":"A structured protocol for Preoperative Progressive Pneumoperitoneum (PPP) in Complex Abdominal Wall Reconstruction (CAWR): our York protocol","volume":"29","author":"Abbas","year":"2025","journal-title":"Hernia"},{"key":"2025081700352468000_18.8.e266990.10","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1581088"},{"key":"2025081700352468000_18.8.e266990.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.04.011"},{"key":"2025081700352468000_18.8.e266990.12","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800590507"},{"key":"2025081700352468000_18.8.e266990.13","doi-asserted-by":"crossref","DOI":"10.3389\/jaws.2023.11230","article-title":"Preoperative Progressive Pneumoperitoneum in the Treatment of Hernias With Loss of Domain. 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