Spontaneous Evisceration of Small Bowel in Incisional Hernia

Abstract

Spontaneous rupture of an incisional hernia leading to the evisceration of the intra-abdominal organs is one of the malefic complications seen in these patients. In addition to its rarity, it gets accompanied by possible lethality in the form of incarceration, sequential strangulation, necrosis, and eventual gangrene. If not treated aptly, the clinical scenario could lead to a life-threatening condition with a delay in timely intervention. With less than 20 documented cases, herein, we report a 48-year-old female with a previous history of a midline laparotomy who presented to us with an acute spontaneous evisceration of the small bowel. The patient was immediately decided on surgical management with exploratory laparotomy, adhesiolysis, and primary repair of the abdominal wall defect. Postoperatively, the patient improved without any complications.

Breaking Bad: Spontaneous Rupture of Incisional Hernia

“…The common causes of evisceration are burst abdomens, gunshot injuries, and stab injuries. Spontaneous bowel evisceration from ventral hernia is rare and has been reported from umbilical [1,2], incisional [3][4][5][6], parastomal [7], and inguinal hernia [8], with ascites, pregnancy [9] and obesity as predisposing factors. Spontaneous rupture of umbilical hernia and a sudden rush of fluid in patients of long-standing ascites is called "Flood Syndrome".…”

“…Spontaneous rupture of umbilical hernia and a sudden rush of fluid in patients of long-standing ascites is called "Flood Syndrome". The reported incidence of incisional hernia is 11-20% [5], with more prevalence in females attributed to lower abdominal surgeries like hysterectomies and caesarean sections (c-sections). A large hernia, contained only by its sac along with thinned-out, atrophic, avascular overlying skin, and added on by a sudden increase in intra-abdominal pressure while coughing or straining, usually leads to spontaneous rupture and evisceration.…”