Case Report

Giant Primary Abdominal Wall Hernia: Case Report of the Surgical Treatment with a Review of the Literature

by Johanna CF Willburger 1*, Giacomo L Angelastri 2

Department of General Surgery, GZO Wetzikon, Wetzikon, Zurich, Switzerland

Department of General Surgery, Luganese Clinica Moncucco, Lugano, Ticino, Switzerland

*Corresponding author: Willburger JCF, Department of General Surgery, GZO Wetzikon, Wetzikon, Zurich, Switzerland

Received Date: 20 November 2023

Accepted Date: 25 November 2023

Published Date: 28 November 2023

Citation: Willburger JCF, Angelastri GL (2023) Giant Primary Abdominal Wall Hernia: Case Report of the Surgical Treatment with a Review of the Literature. Ann Case Report 8: 1526. https://doi.org/10.29011/2574-7754.101526

Abstract

Introduction: Primary abdominal wall hernias can occur in different locations and sizes. The hernia gaps can originate either due to embryonic weaknesses or the yielding of connective tissue due to excessive intra-abdominal pressures. Surgical treatment should be discussed in the event of an emergency situation, disturbing symptoms, or prevention of complications. Case Presentation: In this case report we present a delay treatment of a giant primary ventral abdominal wall hernia, which is rarely seen in Switzerland, due to a normally earlier desired treatment of the patient. Despite delay, treatment could be performed according to the most up-to-date hernia recommendations which are discussed, including a brief review of the literature. Conclusion: A key factor in the successful treatment of large hernias is good communication and clear explanations of the procedure with the patient and his or her relatives. In addition, cooperation between the disciplines involved is crucial for the sometime prolonged follow-up. For an improvement of the evidence in hernia surgery, further case and series reports are essential to be able to offer the best possible care, individualized to our patients.

Keywords: Abdominal-Wall Hernia; Transversus-AbdominisRelease; Poly-4-Hydroxybutyrate Mesh

Abbreviations: ASIS: Anterior Superior Iliac Spin; TAR: Transversus-Abdominis-Release

Introduction

Primary abdominal wall hernia is a worldwide common disease, with an estimated occurrence of 20% in adults [1]. A primary (non-incisional) hernia mostly occurs in the naturally weak points of the abdominal wall. In addition to the inguinal area, this mainly affects the umbilical and epigastric region. There is an indication for treatment in case of incarceration (emergency) or discomfort of the patient. High intra-abdominal pressure (e.g. obesity, chronic cough, chronic obstructive pulmonary disease, vomiting, ascites, pregnancy) can significantly increase the risk of development as well as the size of the hernia sac. Smoking and alcoholism are additional risk factors that should be addressed and minimized, if possible, before treatment is desired [2].

Case Presentation

A 58-year-old male patient presented to our clinic in October 2022 with a huge primary umbilical/ventral hernia (EHS classification M3W3). He reported having the hernia for at least 7-8 years, with rapid increase in size over the past 6 months. Despite the enormous size of the hernia, he had no symptoms until 2 months before presenting in our clinic. The patient also had type 2 diabetes mellitus on medication (metformin 1000mg 3/d; Ozempic 0.75mg 1/week), hypertension, moderate obstructive sleep apnea/ hypopnea syndrome, bronchial asthma, atrial fibrillation (on Eliquis 5mg 1-0-1) and grade III obesity with a BMI of 47.7kg/m2. He had no prior abdominal surgery.

Clinically, we found a huge ventral abdominal wall hernia with the hernia sac starting above the umbilicus (Figure 1).

 

Figure 1: Pre-Operative clinical finding of the giant ventral abdominal wall hernia. Left in supine position, right standing patient.

The hernia sac overlapped the inguinal/genital region. Preoperative CT scan (24th of October 2022) revealed an abdominal wall hernia with a defect of the abdominal wall measuring 5.5 x 6 cm. The hernial sac included the transverse colon and parts of the small intestine without signs of incarceration. We estimated a loss of domain of 30% bowel outside the abdominal cavity. In addition, there was a small inguinal hernia on the left side. No other relevant pathologic findings. Sections from the CT scan are shown in Figures 2 to 4 to illustrate the size of the hernia (Figure 2-4).