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Case 169: 'My hernia wont go back in'

This man was putting off having this incisional hernia repaired. It usually did not cause him much trouble, and if it did he could lie down and it would reduce.

For the past 24 hrs it has been tender, painful and will not reduce when lying down.

1. What has happened?

The hernia has incarcerated. A major ventral abdominal hernia of this size will almost certainly contain some bowel, which is now becoming compromised.

2. How would you repair this problematic hernia?

Open technique, resecting non-viable bowel if required. If no resection needed then a repair reinforced with mesh would be ideal to prevent recurrence.

3. When will you do it? It is getting late, the operating theatre is free now but tomorrow there will also be some time at 11am. Tonight or tomorrow?

Do it tonight.

Tonight you will operate and hopefully just reduce contents and apply a mesh.

Tomorrow you will be resecting bowel in an unwell patient.