Abstract
IntroductionCatastrophic hernias account for about 3% of incisional abdominal wall defects treated at the Department of General Surgery Pablo Soria Hospital of San Salvador de Jujuy over the last 10 years. The finding of a perforated sigmoid volvulus within a hernia sack is an extremely unusual finding, not published in medical literature. Case reportWe present the case of a 78 year-old man who was seen by our services 48hours after admission with a severely complicated incisional hernia. The patient had been intubated and was receiving respiratory support after suffering from a cerebrovascular accident. An abdominal x-ray revealed air-fluid levels suggestive of an intestinal occlusion for which the patient needed urgent operative treatment.At the level of the opening of the hernia sack a sigmoid volvulus was observed with an obstructed perforation as well as multiple cecal micro-perforations as part of a closed loop obstruction. DiscussionComplicated megacolon secondary to Chagas disease is a frequent cause for emergency surgery. The presence of complicated megacolon within a severely complicated incisional hernia has not been published. Rapid treatment is needed to prevent morbidity and mortality in such patients. ConclusionsThe presence of a sigmoid volvulus within an incisional hernia sack is an infrequent finding. It requires a high clinical suspicion for the initiation of early treatment.
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