Strangulated Bowel Obstruction due to Internal Hernia in an Abdominal Incisional Hernia Sac Treated with Component Separation Repair—A Case Report—

Abstract

A 57-year-old woman had a non-reducible 30 × 30 cm abdominal incisional hernia for more than 10 years. She developed sudden abdominal pain and vomiting and visited our hospital 15 hours after onset. She complained of severe abdominal pain, and signs of peritoneal irritation were present. Computed tomography (CT) showed findings suggesting strangulated bowel obstruction and ischemic change of the intestine. Emergency surgery was performed. The small intestine with complex adhesions formed an internal hernia orifice in the incisional hernia sac and the other intestine were strangulated and twisted, leading to necrosis. The necrotic intestine was resected and anastomosed. The incisional hernia orifice was 10 × 8 cm², too large to close by direct suture, so it was repaired by component separation repair. After the operation, she developed a wound infection. Puncture drainage of the subcutaneous abscess was performed, and the symptoms improved. Fifteen months after surgery, she has not had a relapse of the infection or a recurrence of the hernia. The selection of hernia repair when the surgical field is contaminated is still controversial, especially regarding the use of mesh. This time, this method without using mesh was selected, and healing was achieved by minimizing the effect of postoperative wound infection.