Gravid Uterus in Neglected Incisional Hernia with Skin Defect—A Clinical Challenge

Abstract

Incisional hernia during pregnancy with whole of gravid uterus as the content of the hernia sac is a rare occurrence. When such hernia is associated with skin defect over the sac, the management gets complicated. Very few such cases are reported in the literature. There is no consensus on the management of these cases in the available literature. Here, we are reporting two such cases managed in different ways and reviewed the literature.Level of Evidence: Level V, Clinical cases

A rare case of an incarcerated incisional hernia with gravid uterus

“…A review of the literature revealed that uterus herniation usually occurs between the gestational period of 4 to 8 months [ 1 ]. At present, there are only 21 reported cases of gravid uterus herniation through incisional hernias and 5 reported cases through umbilical hernias, in which 8 of them were incarcerated hernias with or without strangulation [ 1 , 2 , 5 , 6 ].…”

“…Abdominal wall incision needs to be planned with the aid of diagnostic imaging due to the possible presence of bowel in the hernia sac and thinning of the peritoneum and overlying skin [ 1 ]. Hernia repair with mesh can also be done in 6 to 8 weeks during the postpartum period as the risk of wound disruption will be lower due to abdominal wall changes during pregnancy [ 2 , 8 ]. Tension-free mesh repair is the preferred method as it has a lower recurrence risk compared to suture repair regardless of the hernia size [ 3 , 7 ].…”

“…Tension-free mesh repair is the preferred method as it has a lower recurrence risk compared to suture repair regardless of the hernia size [ 3 , 7 ]. Elective hernia repair during pregnancy is possible but generally avoided due to anaesthetic risk and high hernia repair failure rate due to ongoing uterus enlargement throughout the gestation period [ 2 , 4 ].…”

Incarcerated giant uterine leiomyoma within an incisional hernia: a case report

“…In general, midline ventral abdominal wall hernias contain adipose tissue, small bowel loops, part of the transverse colon, or omentum, as these organs are more freely movable in the peritoneal cavity. In the current surgical literature, several cases of unusual contents found incarcerated in the hernia sac have been reported, such as the ovaries [9] and ovarian tumors [10], hepatic ligaments [8], urinary bladder [11], and gravid uterus [4][5][6][7][12][13][14][15][16][17][18] with/without leiomyomas. Round ligament leiomyomas have been reported within inguinal hernia sacs [19][20][21][22].…”