A 44 year old G4P3 presents with massive hernia recurrence and bowel obstruction. Her symptoms resolve with conservative management, and she is delivered by cesarean section at term with herniorrhaphy performed 10 weeks postpartum.
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Case notes
The patient is an obese 44 year old gravida 4, para 3, with a history of symptomatic ventral hernia occurring after her last pregnancy. The hernia had been previously complicated by exploratory laparotomy with small bowel resection and primary repair with mesh. She presented at 28 4/7 weeks with abdominal pain, nausea, and bilious vomiting. Physical examination demonstrated abdominal distension and tenderness over her vertical hernia repair scar. Laboratory studies were normal. Fetal status was reassuring and preterm labor was excluded. An abdominal x-ray demonstrated mechanical bowel obstruction ( Figure 1 ).
The Department of General Surgery was consulted and recommended a computed tomography (CT) scan. The CT showed a 24 × 10 × 24 cm anterior abdominal wall hernia with extrusion of large and small bowel into the hernia sac without evidence of incarceration or strangulation ( Figures 2 and 3 and Video ).
