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May 7, 1982

A Colocutaneous Fistula in the Inguinal Area

JAMA. 1982;247(17):2407-2408. doi:10.1001/jama.1982.03320420057037

History  A 52-year-old woman experienced sudden pain in her right groin while feeding bales of hay to cattle. A tender swelling appeared in her right groin 48 hours later. One week later she saw her family physician because of reddened swelling in the groin. The swelling was assumed to represent an abscess and was incised. Fecal drainage developed from the site of the incision. Three weeks later the patient was admitted to the hospital and a barium enema examination was performed (Fig 1 and 2).

Diagnosis  Richter's hernia of the cecum.The barium enema examination demonstrated a knuckle of cecum (lateral margin) extending beneath the inguinal ligament to the site of the draining sinus. Figure 1 is a lateral roentgenogram demonstrating the intestinal-cutaneous fistula (arrows). Figure 2 is an anteroposterior roentgenogram showing knuckle of cecum herniated into the femoral canal (arrow).

Comment  A laparotomy was performed that established that the