Presentation
Complex medical history, including morbid obesity, obstructive sleep apnea, and polycystic ovary syndrome, as well as a laparoscopic hysterectomy. Presents with nausea, vomiting, and intractable abdominal pain.
Patient Data
Umbilical hernia with herniation of a small bowel loop along with mesenteric fat. Proximal to the herniated bowel segment, there is dilation of the small bowel loops and there is collapse of small bowel loops distal to the herniated bowel segment.
There is significant subcutaneous fat stranding surrounding the above-mentioned hernia.
These findings may represent an incarcerated hernia.
Case Discussion
The patient presented with symptoms of nausea, vomiting, and intractable abdominal pain. Imaging studies revealed herniation of small bowel loops along with the mesentery into an umbilical hernia, resulting in a small bowel obstruction. This was evidenced by the proximal dilatation of bowel loops with distal collapse. There was also significant fat stranding around the umbilical sac, raising suspicion for an incarcerated hernia.
During surgery, dissection of the hernia sac revealed serosanguinous fluid and a strangulated segment of the small bowel, which was delivered through the hernia. The affected bowel appeared hyperemic.
An incarcerated umbilical hernia should be considered as a potential cause of small bowel obstruction, particularly in obese patients 1.
Contributor and mentor: Dr Ravikumar Hanumaiah
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