Spontaneous Entero-Scrotal Fistula: A Rare Complication of Inguinal Hernia in a Developed Country-A Case Report.

Introduction and Importance: Entero-scrotal fistula is an exceptionally rare and severe complication of inguinal hernias in adults. We present the first reported Australian case, highlighting the unique diagnostic challenges of Richter-type hernias, particularly in socially isolated patients, where presentation is often delayed. Case Presentation: A 71-year-old male with a history of hypertension and chronic alcohol disorder was transferred from a group home with sepsis and a necrotic scrotal ulcer. Computed tomography confirmed a right inguinal hernia with an enterocutaneous fistula originating from the terminal ileum. Intraoperative findings revealed a Richter's hernia with the antimesenteric wall of the terminal ileum incarcerated within the deep inguinal ring, leading to a spontaneous fistula through the scrotal wall. Management involved an ileocecal resection with side-to-side anastomosis and debridement of necrotic scrotal tissue. Due to gross fecal contamination, a primary tissue repair was performed rather than mesh placement. Clinical Discussion: Spontaneous fistulization typically results from prolonged incarceration. In this case, the Richter-type hernia allowed for intermittent bowel patency, which masked typical obstructive symptoms and delayed surgical intervention. In the setting of gross contamination (Type IV), primary suture repair-such as the "Nylon Darn" technique-is preferred over synthetic mesh to prevent prosthetic infection and chronic wound complications. Conclusion: This case underscores the importance of considering socioeconomic factors and atypical hernia types in surgical delays. In contaminated fields, primary tissue repair remains the gold standard to ensure a safe recovery and optimal patient outcomes.