Overall urgent CT abdomen and pelvis showed the complication of incarcerated hernia where the herniated small bowel loops through the incision became perforated due to closed loop obstruction resulting in abscess formation and cellulitis. The presence of large degree of subcutaneous gas raise suspicion of necrotizing fasciitis.

Emergency laparotomy of small bowel resection, primary anastomosis and wound debridement performed.
Intraoperative findings: 10x10cm hernia defect, content was big clump of distal ileum with multiple sites of perforation, 150cm from duodenal jejunal junction, 50cm from terminal ileum. Fecal contamination extraperitoneally and unhealthy anterior abdominal wall.

**Case and image courtesy of Dr Noorakmal Abdullah and Dr Mohd Shafiq (Radiology Department, Hospital Ampang, Selangor, Malaysia)