History of laparoscopic cholecystectomy five years ago. Developed acute severe abdominal pain over an umbilical hernia with nausea and anorexia. Abdominal examination-abdominal distension with large umbilical hernia with ulceration and intestinal evisceration.
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Resuscitation and nasogastric decompression. Emergency exploration-Infraumbilical smiling incision (inflamed appendix, part of caecum, terminal ileum found as contents). Intestine appeared viable and returned to the abdominal cavity. Appendectomy done. Adhesions released and fascia sutured with polypropylene suture
Drain removed on 2nd postoperative day and discharged on 6th postoperative day
History of C-section 30 years back and four incisional hernia repairs: last repair done 20 months back. Large incisional hernia in the right groin and a short segment of intestine eviscerated through the hernia.
Ultrasonography: intestinal segments protruded to the right side of groin. CT scan of lower abdomen-herniation of intestinal segments and mesenteric lipomatous tissue to the subcutaneous area through the muscular defect in the right lower abdominal quadrant.
Segmental resection and end-to-end ileoileal anastomosis was performed. Hernia gap was repaired with primary sutures along with a prosthetic mesh repair. Subcutaneous suction drain kept and wound closed.
Drain removed on 2nd postoperative day and discharged after 5 days. Reexamination in 6 months revealed no signs of hernia recurrence
History of hysterectomy and pelvic lymph node dissection with midline abdominal incision for carcinoma endometrium 1.5 years back (defaulted for adjuvant therapy and follow-up). Presented with burst abdomen and evisceration of bowel following bending.
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Emergency laparotomy: findings revealed 8 cm rectus sheath defect with gangrenous bowel loop protruding from the skin gangrenous small bowel was resected and end to end anastomosis was done. Anatomical repair of the hernia was done.
3 cm marginal flap necrosis noted postoperatively which was debided and secondary suturing was done. Patient was asymptomatic until 2 months of follow-up.
History of two previous caesarean sections: last being done 10 months back. Dehiscence of the wound following the surgery and appearance of an incisional hernia six months later. At presentation-bowel loops protruding through the distal part of a lower midline hypertrophic scar.
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Emergency exploration-eviscerated bowel loops irrigated and returned to the abdominal cavity. Defect closed with nonabsorbable interrupted stitches
Followed up for over 12 months without evidence of recurrence
History of total abdominal hysterectomy done 6 years prior ruptured incisional hernia with evisceration of small gut through the lower half of infraumbilical vertical scar
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Surgical exploration: hernial contents reduced gap in the rectus sheath repaired anatomically with polypropylene sutures
Uneventful recovery discharged on the 11th postoperative day no complication or recurrence noted after one year of follow-up
History of abdominal surgery over 20 years ago. Presented with acute abdominal pain, multiple episodes of vomiting and protrusion of 40 cm of small bowel through an incisional hernia for 4 hours. Chronic cough associated with weight loss for 6 months was noted.
Haemoglobin: 11.1 g/gl WBC: Platelets:
Resuscitation and emergency surgery. Laparotomy-Adhesiolysis and reduction of the bowel to the peritoneal cavity and fascia closed with nylon.
Recovery was uneventful. Diagnosed to be positive for HIV 1 and referred to the medical team. Discharged on the 4th postoperative day and lost to follow-up.
History of emergency abdominal aortic aneurysm repair with a development of a large incisional hernia. Presented with spontaneous rupture of incisional hernia with his appendix and greater omentum protruding out.
CT scan: large defect measuring cm containing the bowel, omentum, and evisceration of the appendix
Emergency incisional hernia repair with open appendectomy. Collagen mesh was used to achieve closure of the myofascial defect. Abdominal binder was applied.
Discharged on 6th postoperative day. Review after 7 weeks showed no evidence of recurrence or infection.
History of emergency laparotomy for tubercular ileal perforation 10 years ago. Bowel protrusion from a ruptured ventral incisional hernia. Hypertensive (206/158 mmHg), tachycardic (106 beats per minute), and pale on presentation.
Full blood count, renal functions and blood sugar were normal. Arterial blood gas: mild respiratory alkalosis.
Nitroglycerine intravenous infusion to lower the blood pressure. Emergency surgery: a loop of small bowel was found adherent to superior aspect of the hernial defect and was dissected free. Hernial sac with redundant skin was excised and large hernial defect of about cm in size was closed by polypropylene mesh underlay repair
Postoperative period was uneventful except for a minor stitch abscess at the lower end of the wound that cleared in 3 days. Discharged on the 8th day at 2-year follow-up, no recurrence was noted.
History of laparotomy and abdominal hysterectomy 1 year back and appearance of hernia after 3 months of surgery. Had acute pain and evisceration of the bowel for 30 minutes. Abdominal examination-large swelling of >20 cm in diameter in the upper half of subumbilical midline scar and evisceration of two loops of jejunum.
Haemoglobin-10.3 g/dL; WBC: ; Platelets:
Resuscitation and emergency surgery. Surgery: hernial sac was dissected and returned to the peritoneal cavity with the bowel. The defect was enlarged by a midline incision up to the umbilicus and down to the pubis and closed with nylon. A cm polypropylene mesh was sutured to the closed defect.
Postoperative period was uneventful and discharged on the 5th postoperative day. Follow-up at 6 months showed no signs of recurrence
History of laparotomy 8 years back and development of an incisional hernia 2 years prior. Presented with omentum protruding through the anterior abdominal wall when she was lifting a weight.
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Surgical exploration: central part of thinned out sac and sheath was found. After excising the omentum, abdominal viscera were examined and were normal. Primary closure of the sheath was done. Plane created for meshplasty and done with a prolene mesh.
Postoperative period was uneventful. Wound healed well without any infection.
Past history of primary surgical repair of a strangulated umbilical hernia 4 years prior with subsequent exploratory laparotomy for postoperative adhesions. Significant past medical history of Child–Pugh’s B liver cirrhosis, with complications including portal hypertension, esophageal varices, and ascites. Bed bound patient. Hypothermic, hypotensive, tachypneic on presentation with irreducible eviscerated congested small bowel from a skin defect of 4 cm, with impingement of the mesentery.
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Resuscitation with emergency surgery, skin defect extended as a limited midline laparotomy incision. 2.5 L of ascitic fluid drained. Congested but viable small bowel loops were reduced into the peritoneal cavity. Biologic mesh was fashioned in size and anchored in-lay to the widely retracted fascia
Patient did not experience any hernia recurrence. Passed away after 2 years from pneumonia.
Past history of hysterectomy 12 years prior complicated by urinary fistula for which laparotomy and repair was done. Development of incisional hernia few years later managed with an abdominal corset. Presented with one-week history of progressive abdominal pain, vomiting, and absolute constipation. On examination: proximal small bowel obstruction secondary to a tender, large, and irreducible incisional hernia with a faecal fistula at its apex
Full blood count and serum biochemistry normal were normal.
Resuscitation with fluids and nasogastric decompression. Laparotomy grossly dilated small bowel loops incarcerated in an incisional hernial sac. Hernial sac was excised en bloc with the incarcerated and fistulating ileal loop. Ileoileal anastomosis was made and hernia defect was repaired with Jenkin’s mass closure suture technique.
Recovery complicated by a copious seroma for a week that led to superficial wound dehiscence and mild wound infection—managed with daily dressings and 1-week course of broad-spectrum intravenous antibiotics. Discharged two weeks after surgery. At three months, wound was completely healed and no evidence of recurrence was noted.
