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Case Reports
. 2024 Oct 14;16(10):e71497.
doi: 10.7759/cureus.71497. eCollection 2024 Oct.

Incarcerated Incisional Hernia: An Unusual Presentation of Metastatic Endometrial Carcinoma

Mang Ning Ong  1 , Guo Hou Loo  1 , Guhan Muthkumaran  1 , Suria Hayati Md Pauzi  2 , Nik Ritza Kosai  1
Affiliations
Case Reports

Incarcerated Incisional Hernia: An Unusual Presentation of Metastatic Endometrial Carcinoma

Mang Ning Ong et al. Cureus. .

Abstract

Abdominal wall hernia is a common condition seen in the clinical practice of surgery. However, malignant tumors in the hernia sac are rare and there are limited studies on this subject. We report a case of a 77-year-old female who presented with generalized abdominal pain and vomiting. She was treated for an incarcerated incisional hernia and underwent an exploratory laparotomy, which showed a multiseptated incisional hernia sac. Histopathological examination revealed a metastatic endometrial serous carcinoma (ESC). ESC is an aggressive variant associated with poor prognosis, characterized by metastasis and extrauterine spread. Its treatment mainly involves a multidisciplinary approach, including surgical treatment and chemoradiotherapy. This report highlights the importance of considering malignant tumors in the differential diagnosis of hernia sac contents. Raising awareness among healthcare professionals and the general public can aid in the prompt diagnosis, appropriate treatment, and improved outcomes for individuals with such rare presentations.

Keywords: endometrial serous carcinoma; gynaecological malignancy; incarcerated incisional hernia; incisional ventral hernia; strangulated ventral hernia.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT abdomen (coronal view)
The image shows incisional hernia with thickened hernia sac with small bowel content (yellow arrow) CT: computed tomography
Figure 2
Figure 2. CT abdomen and pelvis (axial view) at the level of the pelvis
The image shows the incisional hernia with thickened hernia sac (yellow arrow) CT: computed tomography
Figure 3
Figure 3. Intraoperative image showing loops of small bowel with clumped omentum, with part of the fibrosed hernia sac adhered with small bowel
Figure 4
Figure 4. Specimen image of the en-bloc resected small bowel (100 cm in length) with thickened hernia sac
Figure 5
Figure 5. Histopathological images
(A) Malignant cell infiltration is observed within the fibrous adhesion (H&E, 4x). (B) The malignant cells are arranged in clusters with occasional lumen seen exhibiting enlarged hyperchromatic nuclei and small nucleoli (H&E, 20x). (C) Tumor deposits on the serosal surface of the small bowel (blue-inked area) (H&E, 4x). (D) The malignant cells show similar cytomorphology as in (A) (black arrow) (H&E, 20x)
Figure 6
Figure 6. Immunochemistry staining slide images
(A) The tumor cells are immunopositive positive to CK7 (10x), (B) CA125 (10x), and (C) p53 (10x). (D) CK20 stain is negative (10x)
Figure 7
Figure 7. Sagittal view of T2-contrasted MRI of the pelvis
The image shows cervical endometrial malignancy with cervical stroma invasion (white arrow) along with thickened peritoneum (green arrow) MRI: magnetic resonance imaging
See this image and copyright information in PMC

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