Novel Technique In Strangulated Para-Umbilical Hernia Repair Under Local Anaesthesia Block For High-Risk Patient : Case Report

Abstract

Background: Strangulated hernia is one of the most emergency cases that require surgery under general anaesthesia. Here, we present a rare case of strangulated PUH repair done under rectus sheath block (RSB). Case Presentation: We report here a case of a 74-year-old male with diabetes mellitus, hypertension, ischemic heart disease with ejection fraction 20% who presented to our ER with peri-umbilical hernia (PUH) swelling and constipation. On examination, incarcerated PUH was found with massive ascites. Under local anaesthesia, rectus sheet block was performed. During midline laparotomy, there was a supra-umbilical hernia defect of about 3 cm narrow neck containing bowel loop about 5-7cm in length, initially appeared ischemic then regain Its normal colour, primary repair done for the defect. No complication was observed in the post-operative period. Discussion: Strangulated hernia is an emergency case that requires surgical intervention, hernia reduction and resection of necrotic tissue if needed. PUH repair as a day case by using local anaesthesia is a good option as it has advantages of low recurrence and infection rate. For patients with 3 to 4 ASA class, general or spinal anaesthesia is risky, and RSB is the best alternative option in such high-risk patients. Conclusion: Rectus sheath block is a good option for strangulated PUH patients.