Management of a Voluminous Incisional Hernia – Case Report and Brief Review

DOI: 10.2478/jim-2022-0002

Introduction: Massive ventral hernia repairs may lead to abdominal compartment syndrome,
which is associated with increased morbidity and mortality, and is caused by an acute rise in
intra-abdominal pressure, frequently leading to multi-organ failure and possibly death. This
report presents a case with a voluminous incisional hernia associated with intestine obstruction
and the issues surrounding emergency surgical treatment. Case report: An overweight
67-year-old patient with a medical history of diabetes and multiple cardiovascular pathologies
presented to the emergency department complaining of abdominal distension, pain, nausea,
vomiting, and lack of intestinal transit for 48 hours. A clinical diagnosis of bowel obstruction
was established, caused by a large ventral hernia. During surgery, a tension free abdominal
wall reconstruction was performed with a peritoneal flap from the hernia sac and retromuscular
Prolene synthetic mesh. A Redon-type drainage of the posterior rectus compartment and subcutis
was applied for 48 hours. After the operation, the patient was transferred to the intensive
care unit for monitoring. During the follow-up, continuous monitoring of arterial blood pressure,
oxygen saturation, renal function, daily diuresis, lactic acid values, and intraabdominal pressure
was performed. On the 9th postoperative day, the patient was released in good general
health, stable from a cardiorespiratory point of view, with a clean, healing surgical wound.
Conclusion: The repair of large ventral hernias is technically challenging. The management of
giant incisional hernias is complex, requiring thoughtful preoperative evaluation with CT imaging
and volumetry calculation, which can help establish the surgical strategy.
Keywords: voluminous ventral hernia, intraabdominal pressure monitoring, abdominal compartment syndrome