Incarcerated abdomen wall hernia in an elderly patient

A 67-year-old female had a medical history of type 2 diabetes and hypertension with medical control. She also had a history of acute appendicitis and underwent appendectomy 8 years ago. She had a small right abdominal wall mass later and it can easily be pushed into the abdominal cavity. She did not pay much attention to it. She had mentioned a growing palpable mass in the right lower abdominal area since 3 weeks ago and it cannot be pushed into the abdominal cavity. In addition, constipation was noted recent 3 days with increased emesis for 1 day. Physical examination revealed generalized severe abdominal tenderness with a fixed, non-mobile 10-cm hard mass palpable on the right abdominal wall. The laboratory data revealed an elevated white blood cell count of 13 200 per microliter. Abdominal CT determined short segmental, small bowel loops trapped in a lower right abdominal wall defect, and an incarcerated abdominal hernia was diagnosed (Figure 1). The surgeon performed an emergency laparoscopic repair of the incarcerated hernia using a 10 × 15 cm anatomic mesh within 6 h. Following the surgery, the patient's recovery was gradual.

Abdominal wall hernias are suspected based on patient history and confirmed by examination and imaging. Pain caused by the trapping of the bowel and omentum (i.e., fat) is common. In abdominal wall hernia with incarceration justifies an emergency as they are associated with higher morbidity and mortality rates. Older age, high BMI, ASA class III–IV, ascites, and constipation were associated with an incarcerated hernia.¹ In addition, unfavorable outcomes were associated with older age, severe coexisting diseases, and late hospitalization.²

I declare that I have participated in the preparation of the article “Incarcerated hernia in an elderly.” Li-Kai Chang wrote this article. Chia-Yuan Liu and Ming-Jen Chen conducted the literature review. Chen-Wang Chang supported this work by performing a critical reading of the manuscript and supervising the final editing. All authors read and approved the final manuscript.

The authors declare no conflicts of interest.

This study was approved by the appropriate ethics review board (IRB number: 22MMHIS105e).