Giant ventral hernia with bowel obstruction – A clinical case

Abstract text (incl. references and figure legends)

CASE HISTORY: A giant hernia is a challenge for surgeons and more so when in an emergency setting. The European Hernia Society (EHS) considers W3 hernias as the largest defect with more than 10 cm in width or length. Giant hernias produce a morbid condition with chronic inflammation of the mesentery and intestine which leads to the formation of bowel adhesions.

CLINICAL FINDINGS: 64-year-old male presenting with abdominal pain, fever and constipation. Physical examination revealed a giant ventral hernia (figure 1), non-reducible, and an acute abdomen. The patient developed septic shock.

INVESTIGATION/RESULTS: Abdominal CT scan revealed a small bowel obstruction.

DIAGNOSIS: Small bowel obstruction due to a band adhesion in a strangulated giant ventral hernia.

THERAPY AND PROGRESSIONS: Antibiotics were initiated, and an emergency midline laparotomy performed. Most of the small intestine was inside the hernia sac and the adhesion band involved the distal part of the ileum. Due to irreversible ischemia, a right hemicolectomy was performed. The hernia defect (EHS M3W3 - figure 2) was repaired with an interrupted suture using a non-absorbable stitch with no tension. After 46 days, the patient was discharged with no abdominal complications during hospital stay.

COMMENTS: In an emergency setting, a primary fascial closure of a giant hernia in a infected surgical field may be possible.

REFERENCES:

1. DAVIS, S. Scott. The SAGES Manual of Hernia Surgery. Second Edition. SAGES University Masters Program. Springer. 2019.

2. BRINDELLI, Arianna. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World Journal of Emergency Surgery. 12:37. 2017. DOI 10.1186/s13017-017-0149-y

3. HENRIKSEN, N.A. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. British Journal of Surgery. Volume 107, Issue 3. p. 171-190. 2020. DOI: 10.1002/bjs.11489

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No.