A Case of Umbilical Hernia in which Internal Hernia Occurred in the Hernia sac, Causing a Colon Skin Fistula

Abstract

The case was a 79-year-old female patient. She presently is obese, with a body mass index of 36. When she was straining to defecate, she found the stool coming out from the right umbilical region. Thus, she visited the nearest clinic and was referred to our hospital for hospitalization and treatment. We found a fist-sized bulge at the umbilical region and mushy feces draining out of the part where skin necrosis had occurred. Abdominal computed tomography revealed a hernia in the umbilical region, with an orifice of 35 × 80 mm. The hernia content covered the small intestine, the large intestine, and the greater omentum, and free air was found to exist in the hernia sac. Based on the diagnosis of bowel perforation accompanying hernia incarceration, we performed the following surgery. We made a median incision, to extend the surgical wound of the skin fistula. We circumferentially detached the hernia sac under the skin to open the space and found that the greater omentum was adhered to the hernia sac, and that the transverse colon was prolapsed from a gap in the greater omentum and was incarcerated and perforated. The small intestine did not show any sign of ischemia, and strangulation by the umbilical hernia itself was not observed. We excised the perforated part and made a functional end-to-end anastomosis by using an end GIA. Due to the contaminated wound, we did not use meshes and finished the hernia repair by adopting a simple closure. Post-operative conditions were good, and the patient was discharged on day 20.