Unusual complications of incisional hernia

Abstract

Incisional hernia represents a breakdown or loss of continuity of a fascial closure. These hernias are of particular concern not only for the high recurrence rates among them but also for the challenges that follow their repair. It is known to occur in 11-23% of laparotomies. This paper presents two unusual complications of incisional hernia managed by the authors. One ruptured incisional hernia with evisceration of gut and a case of incarcerated gravid uterus in a woman in labour. The case records of the two patients with unusual complications of incisional hernia were pooled and presented to highlight the clinical presentation and management options of this condition. The patient with ruptured hernia and eviscerated gut presented immediately and was resuscitated and the hernia repaired with polypropylene mesh. The patient with incarcerated uterus had caesarean section and mesh repair of the hernia. Incisional hernia can present with unusual complications. The management is very challenging. Good knowledge and skills are required to deal with this condition.

Large Post-Surgical Incisional Hernias: Case Reports and a Review of Barriers Against Early Presentation and Refusal to Consent to Surgery

“…5,8,9 The emergency nature of the surgeries, with a high incidence of infection following the surgery, and the experience of the surgeons who performed the surgeries have been implicated as being responsible for the high number of laparotomies and cesarean sections resulting in incisional hernias. 4,5,6 Incisional hernias can present almost soon after the primary surgery or several years after. 4,5,10 The two cases reported here did not seek medical advice many years after the primary surgery, even though the swellings were noticed about a year after the primary surgery.…”

“…Several authorities have reported that patients with incisional hernias only seek surgical repair because of physical discomfort or complications. 4,5,6,7,9 In sub-Saharan Africa, delayed presentation by patients with post-surgical incisional hernia is traceable to a number of varied factors. Ayandipo 11 and colleagues, working in Ibadan, southwestern Nigeria, implicated low socioeconomic status and very inadequate privately funded health care financing as being responsible for delayed presentation.…”

“…5 In sub-Saharan Africa, only a few patients with incisional hernias seek medical care, and only a very small fraction of them consent to surgical repair even when there are associated physical discomfort and complications. 6,7 Presented here are two cases of complicated large long-standing post-surgical incisional hernias that declined surgical repair despite associated complications. The barriers to early presentation and refusal to consent to surgery in our environment are also discussed.…”

Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique

“…A bdominal incisional hernia is a relatively common surgical disease, with an estimated incidence of around 15-20% of all laparotomies 1 . Without treatment, it tends to increase progressively and complicate with incarceration 2,3 , obstruction, strangulation 4 , deviation of the lumbar spine with low back pain, skin ulcer, skin infection, hernia rupture 2 , loss of domain 5 , muscle changes 6 , circulatory changes 6 , respiratory failure 7 , and tends to worsen patients' quality of life 8,9 .…”

Incisional hernia at “Guglielmo da Saliceto” hospital of Piacenza in Italy: Epidemiological, anatomical and therapeutic aspects

“…Incisional hernia is a common complication following abdominal surgery, occurring in 10 to 20% of cases after laparotomy, but may also occur following laparoscopy [1] . The potential gravity of their typical complications such as strangulation, and atypical ones, such as evisceration, gravid visceral incarceration [2] justifies elective surgical management.…”