Incarcerated Epigastric Hernia

Abstract

An epigastric hernia is a form of ventral hernia. Most of these contain preperitoneal fat or the omentum. Herniation of intra-abdominal organs, a rare form of rectus sheath midline herniations, is seldom seen, and incarcerations in these cases are rare. A 56-year-old male presented with complaints of irreducible epigastric swelling. Thorough clinical examination and imaging studies revealed that the patient had an epigastric hernia. An intraoperative image showed that the small bowel had herniated through the epigastric defect and was obstructed; however, the small bowel was viable. The contents were reduced after enlarging the constricting ring, and anatomical repair with mesh reinforcement was done. Postoperatively, the patient had an uneventful recovery and was discharged.

Keywords: epigastric hernia; incarcerated hernia; intestinal obstruction; meshplasty; obstructed hernia.

Figure 1. Clinical image showing irreducible epigastric hernia (arrow)

Figure 2. Abdominal X-ray showing (A) multiple dilated air small bowel loops (arrow) and (B) multiple air-fluid levels (arrow)

Figure 3. Intraoperative image showing herniated small bowel loop through the epigastric defect