MANAGEMENT OF INCARCERATED VENTRAL HERNIA WITH OBSTRUCTION IN PREGNANCY - A CASE REPORT

Objectives: Incarcerated ventral hernia causing bowel obstruction is a rare complication in pregnancy. Discussed is a multi-disciplinary approach to a pregnant patient who presented with an incarcerated ventral hernia and intestinal obstruction.

The patient is a multiparous woman estimated to be at 31 weeks gestation who presented with several days of persistent abdominal pain with associated nausea and vomiting. CT imaging revealed a large right paramedian ventral hernia containing distended loops of bowel. A trial of conservative management was attempted with bowel rest and nasogastric decompression. However, she failed to improve and developed worsening abdominal pain. After discussion between multiple medical specialties, the patient proceeded to the operating room in a collaborative effort by general surgery and obstetrics. A midline laparotomy was performed and the hernia contents were reduced; the bowel was inspected and appeared viable. The obstetrics team then performed a repeat Cesarean section and bilateral salpingectomy. The case was concluded with open ventral hernia repair with retrorectus mesh placement. The patient experienced mild ileus post-operatively with an otherwise uncomplicated recovery while her infant progressed well in the NICU.

Bowel obstruction in pregnancy is rare. It is most commonly caused by adhesions and can often be managed conservatively. However, obstruction secondary to incarcerated hernia often necessitates operative management. This case report demonstrates successful multi-disciplinary management of a bowel obstruction secondary to an incarcerated ventral hernia during pregnancy.

Methods:

Results:

Conclusion: