RESUMO
BACKGROUND: Triple combined hernias are rare surgical presentations where three different tissues protrude through abdominal wall weaknesses. Amyand's hernia involves appendix entrapment within an inguinal hernia, while Richter's hernia entraps bowel circumference in the sac. The combination of sliding bladder hernia, Amyand's, and Richter's hernia has not been documented in medical literature, making preoperative diagnosis challenging. Ultrasound and CT scans may be helpful. CASE PRESENTATION: A 50-year-old man presented to the Emergency Department with a strangulated inguinal hernia. Initial diagnosis based on clinical signs, ultrasound, and X-ray led to surgery. The unexpected Intraoperative finding was a triple hernia, a sliding bladder hernia combined with Richter's and Amyand's hernias. Surgery involved removal of the sac, repairing the weakened abdominal wall, reinforcing the bladder wall, and removing a necrotic portion of the ileum with reconnection. Additionally, an appendectomy was performed. The patient recovered well and was discharged without complications. DISCUSSION: A triple hernia, a combination of sliding bladder and Amyand's and Richter's hernias, is rare in elderly males with strangulated inguinal hernias. Preoperative diagnosis remains challenging, with imaging techniques like ultrasound and CT scans limited. Maintaining a high index of suspicion is crucial for unusual hernia presentations, especially in elderly males, and early surgical exploration is essential to avoid complications. CONCLUSION: This case highlights the extreme rarity and diagnostic difficulty of a triple combined hernia. Strangulated inguinal hernia with partial intestinal blockage in patients. It points out the critical importance of early surgical exploration in older males with strangulated inguinal hernias, particularly given the limits of preoperative imaging in recognizing these uncommon presentations.
