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Carbuncle of groin — Clinical Guidelines

Overview

Carbuncle of the groin, often associated with incarcerated groin hernias, represents a surgical emergency characterized by severe pain, swelling, and potential bowel compromise requiring prompt intervention to prevent complications such as bowel resection and sepsis. 3 4

Diagnosis

Clinical Presentation: Severe pain, swelling, and possible signs of systemic infection or bowel obstruction.

Risk Factors: Neutrophil-to-lymphocyte ratio (NLR) >3.36, presence of bowel obstruction identified preoperatively 3.

Imaging: Ultrasound and MRI can help assess the extent of hernia incarceration and bowel involvement, though their specificity varies 8 10.

Laboratory Tests: Elevated NLR may predict the need for bowel resection 3.

Management

Surgical Intervention: Emergency surgical repair, often open due to the acute nature, but laparoscopic approaches show promise with shorter hospital stays and lower infection rates 1 2.

Bowel Resection: Indicated in cases of bowel ischemia or necrosis, with 15.6% requiring resection in one study 3.

Mesh Use: Mesh repair associated with decreased recurrence rates compared to non-mesh repair 5.

Postoperative Care: Focus on infection prevention, monitoring for complications like seroma and recurrence, with emphasis on follow-up adherence 5.

Special Populations

Developing Countries: Higher rates of emergent presentations linked to socioeconomic factors like family obligations and lower education levels 4.

Comorbidities: No specific guidelines provided in abstracts; however, comorbidities may influence surgical approach and postoperative outcomes 5.

Key Recommendations

Prompt Surgical Intervention: Emergency surgical repair is crucial for incarcerated groin hernias to prevent bowel necrosis and systemic complications (Evidence: Strong 3 4).

Consider Laparoscopic Approaches: For suitable patients, laparoscopic repair may reduce hospital stay and infection risk compared to open surgery (Evidence: Moderate 1 2).

Utilize Mesh in Repair: Incorporate mesh in surgical repairs to decrease recurrence rates (Evidence: Moderate 5).

Monitor NLR Preoperatively: Elevated NLR may indicate higher risk for bowel resection, guiding surgical planning (Evidence: Moderate 3).

Enhance Postoperative Follow-Up: Ensure patients adhere to follow-up appointments to monitor for complications (Evidence: Expert opinion based on recurrence rates noted 5).

References

1 Lai SD, Smith NJ, Park B, Vandal A, MacCormick AD. Laparoscopic Versus Open Approach for Emergency Repair of Groin Hernias: A Systematic Review and Meta-Analysis. World journal of surgery 2025. link 2 Correia de Sá T, Jácome F, Basto T, Costa M, Gonçalves Á, Teixeira N et al.. Transabdominal preperitoneal (TAPP) repair for emergency groin hernia: a systematic review. Hernia : the journal of hernias and abdominal wall surgery 2024. link 3 Chen P, Yang W, Zhang J, Wang C, Yu Y, Wang Y et al.. Analysis of risk factors associated bowel resection in patients with incarcerated groin hernia. Medicine 2020. link 4 Ochoa-Hernandez A, Timmerman C, Ortiz C, Huertas VL, Huerta S. Emergent groin hernia repair at a County Hospital in Guatemala: patient-related issues vs. health care system limitations. Hernia : the journal of hernias and abdominal wall surgery 2020. link 5 Dai W, Chen Z, Zuo J, Tan J, Tan M, Yuan Y. Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia : the journal of hernias and abdominal wall surgery 2019. link 6 Hölmich P, Thorborg K, Nyvold P, Klit J, Nielsen MB, Troelsen A. Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain? Outcome 10 years after baseline assessment. British journal of sports medicine 2014. link 7 Sheen AJ, Stephenson BM, Lloyd DM, Robinson P, Fevre D, Paajanen H et al.. 'Treatment of the sportsman's groin': British Hernia Society's 2014 position statement based on the Manchester Consensus Conference. British journal of sports medicine 2014. link 8 Genovese EA, Tack S, Boi C, Fonio P, Cesarano E, Rossi M et al.. Imaging assessment of groin pain. Musculoskeletal surgery 2013. link 9 Lovell GA, Blanch PD, Barnes CJ. EMG of the hip adductor muscles in six clinical examination tests. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine 2012. link 10 Jansen JA, Mens JM, Backx FJ, Stam HJ. Diagnostics in athletes with long-standing groin pain. Scandinavian journal of medicine & science in sports 2008. link

Carbuncle of groin