HERNIAS • SENIOR RESIDENT / SURGEON

Incarcerated Ventral Hernia

An acutely painful irreducible ventral hernia becomes an ACS emergency when it causes obstruction or compromises bowel perfusion.

PROTOTYPE REVIEW REQUIRED

The Call

Adult with known ventral/incisional hernia

Sudden focal hernia pain, vomiting, obstipation and a tender irreducible abdominal-wall mass.

Tachycardic

The key question is whether this is incarceration alone or strangulation with threatened bowel.

Read the Image • Clinical Data

CT / Clinical Image Look for bowel within the hernia sac, transition points, closed-loop configuration, edema, free fluid and reduced enhancement. Clinical image slot reserved for this case.

Make the Decision • Commit to a Plan

Incarcerated Ventral Hernia

Adult with known ventral/incisional hernia

A ventral hernia contains small bowel with obstruction, focal tenderness, tachycardia and CT mesenteric edema. Best next step?

A contaminated field is created by resection of nonviable bowel. The fascial defect can be closed without tension. Best principle for hernia reconstruction?

POD 3 the patient develops worsening pain, leukocytosis and drainage from the incision. Best next step?

Reduce the hernia, then decide what the bowel and contamination allow.

Recurrence prevention must be balanced against infection risk.

Surgical Pearls

Pitfalls

What finding most strongly turns an incarcerated ventral hernia into an urgent operative problem?