Abstract
Most epigastric hernia contains preperitoneal fat or the omentum. Intraabdominal organ herniation is rare and, if present, contains mostly small bowel. Incarcerated epigastric hernia having the stomach as content is infrequent, and only one case has been reported in the literature so far. Herein, we report a rare case of incarcerated epigastric hernia that contains the stomach and was managed with emergency hernioplasty.
Case report
An 82-year old lady presented to our surgical emergency department with abdominal pain, nausea, and vomiting for 24 h. She had a history of an asymptomatic epigastric swelling for the previous 10 years. She was otherwise well, and had not any previous surgery or abdominal herniation elsewhere. Her vital signs were normal; a tense tender epigastric swelling of 15×15 cm was noted. Bowel sounds were present. Her routine blood investigations were normal. Ultrasonography revealed the stomach to be herniated through a large epigastric peritoneal defect of 49 × 32 mm.
Emergency laparotomy was performed; most of the stomach and greater omentum were found to be herniating through the peritoneal defect (Figure 1). The tissues, being viable, were reduced into the peritoneal cavity after widening the defect slightly, and a hernioplasty using polypropylene mesh fixed with polypropylene 2-0 suture was performed. Her postoperative course was unremarkable and she was discharged on the fifth postoperative day.
The stomach herniating.
Discussion
Epigastric hernias account for c.1.6–3.6% of all abdominal hernias and 0.5–5% of all operated abdominal hernias. 1 We found only one case of an incarcerated epigastric hernia containing the stomach in the literature.2,3 Point-of-care ultrasonography is useful for diagnosis, and sufficed in our case. 4 Tenderness in a large hernia is an indication for urgent exploration, which resulted in a satisfactory outcome.
Incarcerated epigastric hernia having the stomach as content is infrequent, and only one case has been reported in the literature so far. The patient's main concern about this case is epigastric pain, swelling, and vomiting. A high index of suspicion is required for accurate preoperative diagnosis. Ultrasound of the abdomen or computed tomography can accurately diagnose the condition preoperatively. It can either be managed by laparoscopy or laparotomy, depending on the expertise available
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article
Informed consent
Written informed consent was taken from the patient for publication of these images.
