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Suleman K, Wokoh U, Iyer P, Yoong W. Pregnancy complicated by massive incisional hernia: challenges in management and review of literature. BMJ Case Rep 2023; 16:e254637. [PMID: 38129081 DOI: 10.1136/bcr-2023-254637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Pregnancy complicated by incisional hernia is rare but can become an obstetric challenge if the gravid uterus becomes displaced or incarcerated into the hernial sac or if there is ulceration of the overlying dermis as a result of increased intra-abdominal pressure being transmitted to the skin. We report a case of a pregnant woman presenting with a large incisional hernia at 19 weeks of gestation and discuss how problems encountered with progressing pregnancy were managed conservatively by adopting a multidisciplinary team approach (which included surgeons and radiologists). She underwent a caesarean section at 35 weeks of gestation due to active bleeding from the ulcerated skin and foetal growth restriction with subsequent staged secondary hernia repair at a tertiary centre. Close surveillance is mandatory, and a decision on the mode and timing of delivery as well as when to perform the surgical repair of the fascial defect should be team based.
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Affiliation(s)
- Kiran Suleman
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
| | - Uloma Wokoh
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
| | - Priyanka Iyer
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
| | - Wai Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
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Herniation of gravid uterus through an incisional hernia with skin defect and uterine scar dehiscence. Hernia 2019; 24:421-424. [PMID: 31250212 DOI: 10.1007/s10029-019-01994-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
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Ozaki K, Tanimura K, Ebina Y, Kanemitsu K, Yamada H. A pregnant woman with a surgical site infection after mesh repair of an abdominal wall incisional hernia: a case report. J Med Case Rep 2017; 11:66. [PMID: 28283028 PMCID: PMC5346184 DOI: 10.1186/s13256-017-1217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/19/2017] [Indexed: 11/15/2022] Open
Abstract
Background Surgical meshes are widely used in incisional hernia repair. However, there are no reports of pregnancies complicated by infection of surgical meshes used for hernia repair. This is the first case report of a pregnant woman who experienced surgical site infection associated with surgical mesh used for repair of an abdominal wall incisional hernia. Case presentation We report a case of a 41-year-old pregnant Japanese woman with surgical site infection after mesh repair of an abdominal wall incisional hernia. She was diagnosed with an abdominal wall incisional hernia at 3 months after her third cesarean section, and she underwent an operation of hernia repair with use of monofilament polypropylene mesh 7 months after the third cesarean section. However, a surgical site infection associated with surgical mesh occurred. During antibiotic treatment, she was found to be pregnant. She was referred to our hospital at 13 weeks and 2 days of gestation. The surgeons removed the infected mesh at 16 weeks and 3 days of gestation. Neither the hernia nor infection at the surgical site recurred throughout pregnancy. We planned a cesarean section using a transverse uterine fundal incision method with an upper abdominal incision. The patient delivered a 2478-g healthy female infant. Conclusions The present report shows that removal of mesh can safely control surgical site infection during pregnancy.
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Affiliation(s)
- Kana Ozaki
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yasuhiko Ebina
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kiyonori Kanemitsu
- Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Shirol SS, Kamat V, Sanu N, Nayak S, Shaikh H. Gravid uterus in neglected incisional hernia with skin defect-a clinical challenge. Indian J Surg 2015; 77:172-3. [PMID: 25972686 PMCID: PMC4425796 DOI: 10.1007/s12262-015-1237-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/16/2015] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- S. S. Shirol
- Department of Plastic Surgery, KIMS Hubli Vidyanagar, Hubli, 580032 Karnataka India
| | - Vijay Kamat
- Department of Plastic Surgery, KIMS Hubli Vidyanagar, Hubli, 580032 Karnataka India
| | - Nagarj Sanu
- Department of Plastic Surgery, KIMS Hubli Vidyanagar, Hubli, 580032 Karnataka India
| | - Shubha Nayak
- Department of Plastic Surgery, KIMS Hubli Vidyanagar, Hubli, 580032 Karnataka India
| | - Hina Shaikh
- Department of Plastic Surgery, KIMS Hubli Vidyanagar, Hubli, 580032 Karnataka India
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Byun JM, Jeong DH, Kim YN, Jeong CH, Lee KB, Sung MS, Kim KT. Ventral hernia with uterine rupture after vaginal delivery. Taiwan J Obstet Gynecol 2014; 53:389-91. [PMID: 25286797 DOI: 10.1016/j.tjog.2013.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2013] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Ventral hernia is uncommon during pregnancy and is extremely rare in postpartum women. It leads to a life-threatening emergency. CASE REPORT A 33-year-old woman, gravida 2 para 1, was admitted to our institute with severe abdominal pain and overdistended abdomen immediately after a full-term vaginal delivery. She had a normal prenatal course and denied having any medical and surgical history. The primipara woman with no history of abdominal surgery was diagnosed with a ventral hernia with uterine rupture after vaginal delivery. We performed an emergency laparotomy and primary repair of the uterine rupture and abdominal wall defect. An abdominal binder was provided for the postoperative period. The patient's postoperative period was uncomplicated. She was discharged from the hospital after 12 days. CONCLUSION If a patient has hernia-related symptoms or complications, the diagnosis and management of the hernia should be performed as soon as possible, regardless of the onset, to decrease maternal and fetal mortality.
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Affiliation(s)
- Jung Mi Byun
- Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea; Paik Institute for Clinical Research, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea
| | - Dae Hoon Jeong
- Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea; Paik Institute for Clinical Research, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea.
| | - Young Nam Kim
- Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea; Paik Institute for Clinical Research, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea
| | - Chul Hoi Jeong
- Department of Obstetrics and Gynecology, Haeundae Paik Hospital, Busan, South Korea
| | - Kyung Bok Lee
- Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea
| | - Moon Su Sung
- Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea
| | - Ki Tae Kim
- Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea; Paik Institute for Clinical Research, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea
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Palazzo F, Ragazzi S, Ferrara D, Piazza D. Herniated gravid uterus through an incisional hernia treated with the component separation technique. Hernia 2009; 14:101-4. [PMID: 19436952 DOI: 10.1007/s10029-009-0510-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 04/17/2009] [Indexed: 11/26/2022]
Abstract
Herniation of a gravid uterus through an incisional hernia of the anterior abdominal wall is a rare but serious condition due to the potentially severe maternal and foetal risks. Because of the rarity of the condition, no consensus exists regarding the optimal treatment. The component separation technique (CST) has proven to be effective for the treatment of those giant abdominal hernias in which prosthetic material utilisation is not indicated. We report the case of a woman who presented at 38 weeks of gestation with non-reducible herniation of the pregnant uterus through an anterior abdominal wall incisional hernia treated with CST immediately after caesarean section. Review of the existing literature is performed to further underline the efficacy of CST and the need for the practising surgeons to be familiar with this technique and the scenarios when it may become extremely valuable.
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Affiliation(s)
- F Palazzo
- First Division of Surgery, Ospedale Vittorio Emanuele, Catania, Italy.
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Abstract
The herniation of a gravid uterus through an incisional hernia site is a rare occurrence, but the evisceration of the gravid uterus through the incisional hernia is even rarer. The following is a case report of an evisceration of gravid uterus through an incisional hernia of a midline incision.
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Affiliation(s)
- Latika Sahu
- Department of Obstetrics and Gynecology, JIPMER, Pondicherry University, Pondicherry, India.
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Affiliation(s)
- R D Dales
- Kirwan Hospital for Women, Townsville, Queensland, Australia
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Abstract
A case of gravid uterus in an incisional hernia is reported. The pregnancy was further complicated by intrauterine growth restriction, oligohydramnios and pregnancy induced hypertension. The management of the case is discussed.
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Affiliation(s)
- N Banerjee
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi
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Affiliation(s)
- D Deka
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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