Intestinal Occlusion due to a Giant Pedunculated Ventral Hernia: Clinical Case

INTRODUCTION. Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. Its incidence in emergency department patients at 2 to 8% is estimated. Although the morbidity and mortality associated with acute intestinal obstruction have decreased, clinical management remains challenging. CLINICAL CASE. A 60-year-old male with obesity and chronic arterial hypertension. In 2011, he underwent an appendectomy and subsequently developed an incisional hernia. No treatment. Three days before admission, he started abdominal pain at the hernia site, which increased; without reduction of the hernial sac and vomiting on two occasions. Physical examination revealed excess abdominal adiposity, supra and infra umbilical scar with an incisional ventral hernia, 20cm ring, incarcerated 20cm pedunculated sac, with color changes, absent peristalsis in the sac, with no evidence of peritoneal irritation—normal labs. Computed axial tomography reported a wall defect, with a ring located medially at the umbilical level of approximately 19.5 cm in the longitudinal axis and 18 cm in the transversal axis, protruding intestinal loops, fat, and vessels. At 147 cm from the main defect, an annular zone of contraction of 42 mm in diameter with the same content. No evidence of intestinal suffering. Done Exploratory laparotomy with abdominal wall plasty is indicated; a supra and infra umbilical incision in the previous scar; It is dissected by planes, finding a 30-cm hernial sac with a 15-cm pedunculated defect containing intestinal loops of the jejunum and ileum that recover functionality after decompression. Placed Polypropylene mesh and drainage; hemostasis is verified and closed by planes. He leaves the week with antibiotic therapy and pain management. During his postoperative period, they occurred without eventualities. DISCUSSION. The risk of incarceration may increase due to factors such as augmented intra-abdominal pressure, obesity, ascites, chronic cough, and constipation, which have all increased intra-abdominal pressure. Hernia characteristics, such as the location and size of the defect, may also be associated with incarceration. More minor defects have a higher risk of incarceration; however, the evidence supporting this theory is limited. A previous study found no evidence of an increased risk of incarceration in defects smaller than 2 cm, and another recent study found no association between defect size and hernia incarceration.

small bowel obstruction, adhesions, treatment. bowel obstruction, internal hernia, eventration, incarceration 

Rodríguez-Sosa S.H., Nogueira-Echeverría A.E., Rubio-Zapata H.A., Cruz-Mendez A.T., Pat-Cruz F.J., Sollano-Shivy S.D., Padrón-Arredondo G. Intestinal Occlusion due to a Giant Pedunculated Ventral Hernia: Clinical Case. Int. J. Med. Healthc. Res., 2023, 1(1), doi: 10.58531/ijmhr/1/1/5