Strangulated Incisional Hernia Research Articles

Complex management of larger strangulated incisional hernia in a post-multiple abdominal surgery in a morbidly obese patient-a case report and surgical review

Strangulated incisional hernia following a post-hernia repair is a serious and potentially rare life challenging condition that can occur after surgical intervention. Incisional hernias accounts for 15-20% of all abdominal hernias which occur at the site of a previous surgical incision where the integrity of the fascia has not been fully restored. We are presenting a case report of a 49 years lady who came with complaints of abdominal swelling and pain abdomen following multiple abdominal surgeries diagnosed with strangulated incisional hernia following post hernia repair. It was managed by emergency surgical intervention that is removal of previously kept mesh and resection of gangrenous segment of bowel with end ileostomy after keeping overall patient’s condition.

A Patient with Crohn’s Disease Presenting with a Picture Mimicking a Strangulated Incisional Hernia: A Case Report

Objective: To report a case of Crohn’s disease that presented with a clinical picture mimicking a strangulated incisional hernia. Case Report: A 33-year-old Saudi male patient presented to the Emergency Department (ED) with vomiting, pain, and swelling at the right iliac fossa after lifting heavyweight objects two days earlier. The patient had a past history of appendectomy through a transverse incision nine years earlier. Clinically, the patient was vitally stable. He had tenderness at the right iliac fossa, and rebound tenderness. A tender swelling (6 x 8 cm) was observed underneath the previous scar. It was firm, not expansile on cough, and not reducible, with no redness or skin changes. The laboratory report showed normal results for complete blood count, apart from slight leukocytosis. Blood electrolyte levels, renal and liver function tests were normal. Plain CT abdomen showed a defect in the transversus abdominis muscle with the presence of swelling beneath the oblique muscles associated with air, which were connected to the bowel. The preliminary diagnosis was a “strangulated incisional hernia”. After laparotomy, the swelling showed pus within the external oblique aponeurosis, with a fistula tract connected to the ileum. After abdominal exploration, the inflammation was observed to be limited to the ileum and cecum with no other abnormality noted. Ileocecectomy was done with side-to-side anastomosis between the ileum and ascending colon. The resected part was sent for histopathology, which confirmed the characteristics of Crohn’s disease. Conclusions: The diagnosis of Crohn’s disease remains challenging. Its management is multi-disciplinary. Surgical management is dependent on disease location and severity. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease, rather than being a last-resort therapy. Key Words: Crohn’s disease, Diagnosis, Surgical management, Case Report.

Prognostic Score for Assessing the Risk of Incisional Ventral Hernias Strangulation

The problem of treatment for strangulated incisional hernia does not lose its relevance due to the large number of postoperative complications and high mortality rates, which significantly exceed these indicators in selective surgery. One of the solutions to this problem is to identify patients with a high risk of strangulation, which will allow you to perform the operation in a timely manner and avoid possible complications. The most relevant issue is the timing of surgery in patients with postoperative hernias after strangulation.

A Rare Case of Ileo-ileal Fistula within a Strangulated Incisional Hernia 'Fistulation by the Sneaky Plastic Perforator'

Perforation of the hollow viscus by a foreign body is seldom observed in clinical practice. Ileo-ileal fistula secondary to perforation by ingested plastic material is rare entity. Accidental ingestion of a foreign body is often encountered in clinical practice. However, intestinal perforation due to such a cause develops rarely, because the swallowed foreign body usually advances through the gastrointestinal tract without any problems and is excreted with faeces. Only 1% of ingested objects result in gastrointestinal system perforation. Commonly the material should be plastic, glass or iron with sharp edge. However, in our case it was a plastic sheath. Herein, we present a prisoner patient which admitted from casualty with suspected of having strangulated incisional hernia in view of history of previous surgery done. However, on-table a plastic sheath was discovered causing an ileo-ileal fistulation with perforation. This case stands out due to the rarity of its entity, peculiarity of its clinical presentation and complexity of managing this case. This case highlights the suspicion of foreign body ingestion is imperative in diagnosing and managing acute abdominal pain cases among prisoners and drug abusers.

A Rare Case of Ileo-ileal Fistula within a Strangulated Incisional Hernia “Fistulation by the Sneaky Plastic Perforator”

Perforation of the hollow viscus by a foreign body is seldom observed in clinical practice. Ileo-ileal fistula secondary to perforation by ingested plastic material is rare entity. Accidental ingestion of a foreign body is often encountered in clinical practice. However, intestinal perforation due to such a cause develops rarely, because the swallowed foreign body usually advances through the gastrointestinal tract without any problems and is excreted with faeces. Only 1% of ingested objects result in gastrointestinal system perforation. Commonly the material should be plastic, glass or iron with sharp edge. However, in our case it was a plastic sheath. Herein, we present a prisoner patient which admitted from casualty with suspected of having strangulated incisional hernia in view of history of previous surgery done. However, on-table a plastic sheath was discovered causing an ileo-ileal fistulation with perforation. This case stands out due to the rarity of its entity, peculiarity of its clinical presentation and complexity of managing this case. This case highlights the suspicion of foreign body ingestion is imperative in diagnosing and managing acute abdominal pain cases among prisoners and drug abusers.

Comparative Study on the Use of Polypropylene Mesh in the Surgical Treatment of Patients with Strangulated or Uncomplicated Incisional Hernias

Incisional hernias affects approximately 10-20% of patients with history of abdominal surgery. The purpose of this study was to examine the tissue integration of the polypropylene mesh in patients operated for strangulated incisional hernias to those operated for uncomplicated incisional hernias. For this purpose, we introduced 218 patients with surgical treatment of the incisional hernia with polypropylene mesh. The total number of patients studied was divided into 2 lots: group A consisting of 189 patients with uncomplicated incisional hernia and group B of 29 patients with strangulated incisional hernia. We studied separately the local postoperative complications in the two groups (hematomas, seromas, abdominal wall infections). Although the number of local postoperative complications was higher for group B, the differences were statistically significant only for the incidence of abdominal wall infections. Although the use of the polypropylene mesh in the surgical treatment of strangulated incisional hernias predisposes to a higher risk of local postoperative complications compared to its use in the surgical treatment of the uncomplicated incisional hernias, its use in the surgical treatment of the strangulated incisional hernias is beneficial.

Incisional Hernia Repair in Contaminated Surgical fields (I.H.R.C.S.) study using biological prostheses in emergency surgery setting with contaminated hernias: a multicenter prospective observational study

There are still difficulties to find appropriate indication for prosthetic implant in hernia surgery in contaminated surgical fields. Biologic prosthetic materials have been developed and proposed for the clinical use in contaminated surgical fields with interesting outcomes. The aim of this study is to analyze data from nine Italian Emergency Surgery Units concerning patients consecutively admitted with diagnosis of strangulated incisional hernia (IH), submitted to surgery in emergency and treated with biological prostheses. This is a prospective observational study. Subjects submitted to singlestaged IH repair in a contaminated surgical field, with the use of biologic mesh, were prospectively studied over a 1-year time period. All patients enrolled in this study were submitted to bowel/intestinal resection at the same operative time for perforation. Primary end points of our study were wound complication and hernia recurrence. Seventy-one patients were enrolled (F=21, M=50); the mean age was 69.2±11.1 standard deviation (SD) years and the mean American Society of Anesthesiologist (ASA) score was 3.1±0.8 SD. Twenty-one patients (29.57%) had a wound complication, associated with high ASA score, diabetes, smoking, chronic immunosuppression, number of previous hernia repairs, dirty surgical field, sublay extra peritoneal mesh placement and no anterior fascia closure. After a mean follow up time of 27.2 months, hernia recurrence occurred in 19 patients (26.76%). Predictors of hernia recurrence included wound complications, high ASA score, diabetes, chronic immunosuppression, dirty surgical field and sublay extra peritoneal mesh placement. Use of biological prostheses in contaminated fields is safe with favorable medium term recurrence rate (26.76% in our experience). Surgical technique performed is important to decrease hernia recurrence rate.

A Case of Abdominal Wall Endometriosis Mimicking Strangulated Incisional Hernia

Giris: Endometriozis, uterus disinda fonksiyonel endometrial doku varligi ile karakterize bir klinik antitedir. Bu lezyon genellikle overler, rektovaginal bolge ve pelvik taban peritonunda gorulur. Karin duvari endometriozisi, oldukca nadirdir ve genellikle tek olgu sunumlari ya da kucuk seriler olarak bildirilmektedir. Olgu Sunumu: Bu yazida, bogulmus kesi fitigini taklit eden karin duvari endometriozisi olgusu bildirildi. Vakalarin cogu, ozellikle sezaryen gibi cesitli obstetrik ve jinekolojik operasyonlarin ardindan olusur. Karin duvari endometriozisi bazen akut karin bulgularina neden olabilir ve kolayca deri alti apsesi, rektus kilifi hematomu ya da bizim olgumuzda oldugu gibi bogulmus kesi fitigi ile karisabilir. Sonuc: Karin duvari endometriozisinin dogru tanisi genellikle zordur ama ozellikle siklik agrisi olan menstruasyon goren bir kadinda dusunulmelidir. Ayrica, obstetrik ve jinekolojik ameliyat oykusu de sorgulanmalidir. Tedavisi total eksizyondur.

Strangulated incisional hernia after suprapubic catheter insertion: A case report

Introduction: Hernia through the suprapubic catheterization site is extremely rare. Attention is required for such hernias as they can get easily complicated by obstruction and strangulation due to its narrow neck. These are life­threatening complications. Case report: We report a case of a 65­year­old man who presented with a strangulated incisional hernia through the SPC site. He was managed successfully by urgent surgical intervention. Conclusion: Incisional hernia through the suprapubic catheterization site should not be forgotten during examination of patients with abdominal pain, to ensure prompt surgical intervention in case of strangulated hernia.

Hernia incisional gigante complicada. Consecuencias de una evolución prolongada

IntroductionIncisional hernias are the most common cause of intestinal strangulation in patients presenting with intestinal obstruction, potentially complicating with intestinal gangrene, sepsis and eventually intraabdominal hypertension syndrome and its pathophysiological consequences Case reportAn obese woman with a strangulated incisional hernia is herein reported. We discuss the severe consequences and lethal risks to which this patient was exposed as a consequence of her hernia. The clinical course and treatment is reported, stressing the most important clinical and pathological aspects. ConclusionsThis gigantic incisional hernia developed because the surgical treatment was delayed due to a diverse number of factors, the most important of which was the morbid obesity and the fear of postoperative complications frequently developing in such patients. Emergency surgery in these cases represents an increased risk for the patient, the procedure is habitually bloody, and it is associated to severe postoperative morbidity.

Incisional hernia in action: the use of vacuum-assisted closure and porcine dermal collagen implant

In this paper, we describe our experience in the successful use of vacuum-assisted closure (VAC) and porcine dermal collagen (PDC) mesh reconstruction of a complicated contaminated abdominal wall defect resulting from a strangulated incisional hernia with late jejunal perforation in a 57-year-old obese and diabetic woman.

Incisional hernia: An unusual cause of acute pain and swelling following renal transplant

We present a case in which a strangulated incisional hernia following a renal transplant was sonographically diagnosed. The patient presented with acute pain and swelling over the transplant site 6 weeks after surgery. Sonograms showed a normal-sized kidney with normal echotexture, no evidence of hydronephrosis, and no perinephric collections. Color Doppler sonography and spectral analysis demonstrated normal blood flow throughout the kidney. Sonograms showed that the palpable mass was a dilated loop of fluid-filled small bowel. Sonography allowed the correct diagnosis to be established, and early surgical intervention allowed revascularization of viable bowel.

Abdominal wall hernia complicating continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) is a well-established treatment modality for end-stage renal disease. Abdominal wall hernia is not uncommon in patients on CAPD. Two factors are responsible for the occurrence of these hernias: anatomically weak sites and increased intraperitoneal pressure by the dialysate. Abdominal wall hernia was reviewed in 44 patients on CAPD from 1987 through 1991. Eight abdominal hernias (5 inguinal, 2 incisional and 1 umbilical) were found during CAPD treatment (18.18%). Surgical treatment was applied in 6 symptomatic hernias (5 inguinal and 1 incisional). After surgery, 5 patients returned to CAPD without recurrence and the remaining one died of strangulated incisional hernia. Our series shows that: (1) a detailed examination of the preexisting hernia and repair prior to CAPD treatment are suggested. (2) symptomatic abdominal wall hernia should be evaluated carefully and treated promptly. (3) awareness of the complication of these hernias can reduce the morbidity and mortality.