SURGICAL MANAGEMENT OF STRANGULATED INCISIONAL HERNIA - CASE REPORT

Abstract

Case Presentation: A strangulated hernia is characterized by the entrapment of hernial contents, resulting in intestinal obstruction and compromised local blood flow. If not treated promptly, it can progress to ischemia, tissue necrosis, and, in more severe cases, sepsis. In these situations, emergency surgical intervention is essential, aiming to repair the strangulated contents, either by correcting the flow or resecting the organ if necrosis is present. In this report, a 47-year-old woman was admitted to Santa Casa Hospital with diffuse abdominal pain and a bulging abdominal region in an area of ​​a previous surgical scar. An abdominal wall ultrasound was indicated, revealing significant diastasis of the rectus abdominis muscle aponeurosis, associated with a large hernial protrusion through the upper margin of the anterior containment mesh (mesh), containing a bowel loop and omentum, with signs of hernial distress. Emergency surgery was indicated to reduce the hernia contents, without the need for incisional herniorrhaphy. The patient underwent an uneventful procedure. The patient was placed on a diet on the second postoperative day and discharged on the third postoperative day. Introduction: Incisional hernias are common complications after abdominal surgery, primarily due to failure of fascial healing, with an incidence of up to 20%. Initially asymptomatic, they can progress to pain and serious complications, such as incarceration and strangulation, requiring urgent surgery. Their occurrence is associated with risk factors such as advanced age, obesity, chronic diseases, and wound infection. The standard treatment is surgical repair with synthetic meshes, especially polypropylene, which are also recommended prophylactically in high-risk patients to reduce recurrence and improve prognosis. Discussion: Incisional hernias represent a high rate of postoperative complications. Approximately 6 to 15% of them are incarcerated and 2 to 4% are strangulated. Of the latter, 15 to 30% cause loop ischemia requiring resection, while 10 to 20% do not require resection. Their occurrence is associated with risk factors such as advanced age, obesity, chronic diseases, and wound infection. Diagnosis can be challenging in obese patients, requiring imaging. Final comments: The treatment of incisional hernias depends on early diagnosis and appropriate surgical correction to avoid serious complications. The choice of technique and material should consider the size of the defect and the patient's clinical condition. Polypropylene meshes stand out as a safe, effective, and low-cost option, especially when combined with detailed preoperative planning.