Abstract
In patients with giant incisional hernias, many anatomical and physiological changes turn hernia repair into quite a challenge. The possibility of developing complications as abdominal compartment syndrome after hernioplasty has prompted surgeons to seek for technical options. A tempting alternative is to induce progressive preoperative pneumoperitoneum (PPP) aiming to adapt the organism to an increase in the abdominal content. We describe the case of a patient with giant incisional hernia submitted to PPP. The patient complicated with a very symptomatic pneumomediastinum. Despite being frequently well tolerated, it is important to make a point that the induction of PPP may result in severe complications.
Highlights
The surgical repair of giant hernias remains a challenge for surgeons and may lead to anatomic distortions, intra-abdominal hypertension, abdominal compartment syndrome and increased intrathoracic pressure
Progressive preoperative pneumoperitoneum (PPP) is a technique recommended for patients with giant hernias, when forced reduction of the content might result in abdominal compartment syndrome.[2]
We present a case of a patient with giant incisional right subcostal hernia who underwent PPP and had a rare complication
Summary
The surgical repair of giant hernias remains a challenge for surgeons and may lead to anatomic distortions, intra-abdominal hypertension, abdominal compartment syndrome and increased intrathoracic pressure. A seventy-eight-year-old man presented with a giant incisional hernia, with loss of domain, in the right hipocondrium (Figure 1). It was a result of an urgent open cholecystectomy done one year earlier due to cholecystitis and cholecystopleural fistula. On the 6th day, the catheter implantation site revealed signs of infection, it was removed From this day on, a pneumoperitoneum was carried out through daily abdominal puncture under local anesthesia. We opted for a conservative treatment, with withdrawal of some air through abdominal puncture until symptoms alleviation, and the patient was kept under close observation Three days later, he underwent surgery for hernia repair, the pneumoperitoneum was removed and the hernia was reduced, resulting in a good outcome (Figure 3). Patient presented with a giant right subcostal incisional hernia at admission
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