Can Hernia Repair Sutures Be Easily Ruptured

BMJ Case Rep. 2022; 2022: bcr1120103486.

Rare disease

Spontaneous rupture of incisional hernia: a rare cause of a life-threatening complexity

Abstract

Spontaneous evisceration is a very rare and potentially fatal complication of intestinal-wall incisional hernia. Hither the authors nowadays a case report of spontaneous evisceration in an incisional hernia in a 45-year-old female person patient. Direction of the condition using prosthetic mesh repair risks mesh infection, while the apply of not-prosthetic repair risks recurrence of the hernia due to the absence of stout natural tissues. Use of a biological mesh for the condition seems quite plausible. Thorough saline washes of the eviscerated organ; excision of redundant/unhealthy skin and strict adherence to the fundamental principles of hernia repair is desired in managing the condition.

Background

An incisional hernia develops in the scar of a surgical incision. Rarely, a particularly sparse-walled big incisional hernia may actually ulcerate at its fundus so that omentum/bowel protrudes or in that location is even the evolution of an intestinal fistula. Spontaneous rupture of an intestinal hernia is very rare and usually occurs in incisional or recurrent groin hernia.¹ The literature documents the occurrence of spontaneous evisceration of abdominal-wall hernias in the form of a few case reports only. More than unremarkably, this complication has been reported among patients with tense ascites secondary to chronic liver disease. Its occurrence in the case of incisional hernia in an otherwise healthy patient has been reported only once. This example report from the B P Koirala Establish of Health Sciences in Dharan, Nepal, documents a further instance of spontaneous evisceration in an incisional hernia.

Case presentation

A 45-year-old woman presented to the surgical emergency with a loop of bowel protruding out through intestinal-wall defect post-obit a tour of cough for 1 day. (figure 1A,B)

An external file that holds a picture, illustration, etc. Object name is bcr.11.2010.3486.f1.jpg

(A) and (B) Showing bowel loop protruding out through lower intestinal-wall defect.

Five years before, she had undergone total hysterectomy and bilateral salpingo-oophorectomy. This was followed past wound dehiscence which was airtight with through-and-through deep tension sutures. After one yr, she developed an incisional hernia and was given an abdominal chugalug and advised to lose weight. Later wearing the belt for 2 years, 2 ulcers developed in the skin of the hernia. These were treated with local dressings and by replacement of the chugalug. On 26 June 2010, she presented to our hospital with protrusion of abdominal loops through the apex of the incisional hernia since the final 24 h. The lump had slowly enlarged in size and before admission she likewise noticed a dragging hurting in the epigastrium. This was followed past two episodes of vomiting of stomach content.

On examination, she was calm with normal temperature, pulse charge per unit and blood force per unit area and without evidence of gross cardiovascular or respiratory disease. Abdominal exam revealed a big, 8 inch diameter, lower midline incisional hernia. The hernia was not-tender and was partially reducible through a wide, easily palpable defect in the abdominal wall (effigy 2). The skin overlying the hernia was thinned out and a perforation, about 3 inches long, was seen in the skin. Nigh a feet of pocket-size intestine loop was protruding outside through this defect and this loop was congested, haemorrhagic, but healthy.

An external file that holds a picture, illustration, etc. Object name is bcr.11.2010.3486.f2.jpg

Showing bowel couldn't exist repositioned into abdominal cavity.

Investigations

Blood and urine investigations were normal.

Handling

The patient was operated on an emergency basis and a non-prosthetic repair was performed. During surgery, an ellipse of pare was removed together with a small cuff of adherent sac. The small intestine in the sac and extruded bowel was perfectly salubrious. The eviscerated bowel was washed with normal saline before repositing information technology into the abdomen. Peritoneal closure was easy as only the minimum amount of sac was excised. The wound was closed over a subcutaneous drain. The drain was removed on the third postoperative twenty-four hours.

Outcome and follow-up

The patient made an uneventful recovery and was discharged home on the fifth postoperative day. She has been fit and salubrious and completely symptom-free for last 4 months.

Discussion

Spontaneous rupture of abdominal hernia is a rare upshot which can affect any abdominal hernia but is more than commonly reported in incisional hernia and recurrent groin hernias.² ³ Eight cases of spontaneous rupture of abdominal herniaⁱⁱ ^– ⁹ in the adult age group accept been reported in the literature so far. Hartely³ and Hamilton⁴ reported rupture through lower midline incision while Aggarwal^v plant herniation after upper intestinal surgery following perforated duodenal ulcer. This rupture may be sudden following increment in the intra-intestinal pressure like coughing or lifting a heavy weight, or it may be gradual later developing an ulcer at the fundus of the sac.⁴ In our instance, rupture of the hernial sac occurred considering of sudden increment in intra-intestinal pressure due to excessive coughing.

The large incisional hernia is contained only by its sac and sparse atrophic and avascular peel. Larger the hernia, more atrophic and avascular is the overlying pare, and this, along with sparse sac leads to higher chances of rupture of the incisional hernia.⁵ Diverse factors which can contribute to the rupture of a hernia are friction past the patient's external corset or abdominal support, thin atrophic skin, lack of whatsoever adhesions between bowel and sac, allowing the bowel to human action as a hammer-caput upon the pare.⁶

Complications such equally adhesions, incarceration of bowel and intestinal obstruction, are well documented in association with incisional hernia but spontaneous rupture is very rarely reported in literature.⁷ Afterward Hartely'southward³ study of two such cases, there have been very few case reports documented on this. The incidence of this complication is higher in developing countries compared to developed countries.⁸ Rarely this may pb to obstruction and strangulation of small-scale bowel and generalised peritonitis, a potential cause of death.

Neglect for early operative intervention or delay in seeking treatment increases the gamble of rupture.⁹ Eventration of bowel or omentum demands emergency operation. The hernial contents tin can either exist covered primarily by mesh repair of hernia if the general condition of the patient and local condition of operative site allows or tin exist covered past pare followed by delayed mesh repair.¹⁰

This case report has been presented due to the rarity of this complication. We believe that appropriate early surgical management could have prevented this complication. The principle of early referral and repair of incisional hernias is the key for prevention of this complication besides as the associated morbidity and mortality.

Conclusion

Spontaneous rupture of abdominal hernia is a very rare complication, it usually occurs in cases of incisional hernias. These cases should exist managed past primary repair if there is no gangrenous segment and the contamination is minimal, or past delayed repair if in that location is gross contagion and resection and if anastomosis is required.

Learning points

▶ Spontaneous rupture of incisional hernia is probably rarely reported.
▶ Primary treatment of incisional hernia is surgical repair even when asymptomatic because of its potential to develop complications.
▶ Early surgical treatment can prevent life-threatening complications that include adhesions, incarceration of bowel and abdominal obstacle/strangulation and rarely rupture.
▶ This instance is also important considering information technology highlights the social stigma fastened in revealing incisional hernia in developing countries where diseases are non confessed.

Acknowledgments

The authors are thankful to the Dr Sidharth Koirala, Department of anaesthesiology, B P Koirala Plant of Health Sciences, for his prompt response and input in the to a higher place case.

Footnotes

Competing interests None.

Patient consent Obtained.

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