Groin Hernia Secondary to Traumatic Pubic Diastasis: An Uncommon Anatomical Sequela.

Abstract

Groin hernias are common surgical conditions; however, their occurrence in association with traumatic pubic diastasis is rare and may pose significant diagnostic and operative challenges. Pubic symphysis diastasis alters pelvic biomechanics and disrupts anatomical landmarks, potentially contributing to hernia formation, recurrence, and surgical complexity. We report the case of a 27-year-old male who presented with recurrent left groin swelling and a history of pelvic trauma following a road traffic accident two years earlier. He had previously undergone open mesh hernioplasty and subsequently transabdominal preperitoneal repair for recurrent inguinal hernia. In the current presentation, clinical examination revealed a reducible swelling with cough impulse. Pelvic radiography and 3D CT imaging demonstrated pubic diastasis measuring approximately 6 cm. During surgery, distorted inguinal anatomy and herniation of the urinary bladder and small bowel through the widened pubic symphysis were identified. The herniated contents were reduced, and open reduction and internal fixation of the pubic symphysis were performed, followed by onlay mesh repair. The postoperative course was uneventful, and the patient remained asymptomatic with no recurrence at one-year follow-up. Pelvic instability and anatomical distortion due to pubic diastasis complicate conventional hernia repair and increase recurrence risk. Comprehensive radiological evaluation and tailored surgical planning are essential in such cases. Addressing both pelvic instability and the hernia defect is crucial to achieving durable outcomes. Groin hernia associated with pubic diastasis is an uncommon but clinically significant condition. A high index of suspicion is required in patients with prior pelvic trauma presenting with recurrent or atypical groin swelling. Combined fixation of the pubic symphysis along with mesh hernia repair provides effective and stable reconstruction, minimizing recurrence risk.