A Case of Subxiphoid Incisional Hernia Developed after Omentum and Pectoralis Major Muscle Flap Filling for Mediastinitis

Abstract

The patient was an 82-year-old man, who received a 6-month conservative treatment for mediastinitis following aortic valve replacement and coronary artery bypass surgery, underwent omentum and pectoralis major muscle flap filling. Abdominal pain was reported on the 30^th postoperative day, and a plain computed tomography showed a small intestine prolapse under the skin anterior to the sternum. The primary consideration was intestinal obstruction due to a subxiphoid incisional hernia, and emergency surgery was performed. The small intestine was pulled to release the hernia. The small intestine and its vascular supply were preserved. The hernial orifice was closed via a simple ligation suture by placing the subcutaneous tissue on the sternum. He started oral intake on the fifth postoperative day and was transferred to other hospital on the 12^th postoperative day. His abdominal pain recurred on the 33^rd postoperative day, and a recurrent hernia was observed. No strangulation was observed, and semi-emergency operation was performed after the mesh had been prepared. The small intestine was pulled laparoscopically into the abdomen and repaired by the keyhole method using the mesh. Oral intake was resumed on the fourth postoperative day, and he was transferred to the hospital eight days later. He died of another disease five months postoperatively. However, recurrence of the hernia was not observed.