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Abstract: A 32-year-old patient presented with sudden onset of abdominal pain, nausea and vomiting, and a bulging mass at a previous abdominal wall surgical incision. The patient was treated with incisional hernia repair. One month later, the patient’s wound healed well, the hernia contents were completely retracted, and the peritoneal repair was complete.
Basic information】Female, 32 years old
Disease Type】Incisional hernia
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】August 2020
Treatment plan】Surgical excision (incisional hernia repair) + medication (cefixime pellets)
Treatment period】1 week of hospitalization, 8 days after surgery to review and remove stitches
Treatment effect] The patient’s wound healed well at 1 month after surgery, and the hernia contents were completely retracted with complete peritoneal repair.
I. Initial consultation
The patient, Ms. Zhang, was hunched over and appeared to be in pain, and came to the clinic with the support of her husband. The patient said that she suddenly developed abdominal pain, nausea, vomiting and other symptoms today, and a mass was protruding from the previous abdominal wall surgical incision. We learned from the patient’s history that she had a history of cesarean section 7 years ago. On examination, we found that the patient had a mass at the abdominal incision that could be palpated by hand, and intestinal pattern and peristaltic waves could be seen in the abdomen, and pressure pain appeared when pressed. The patient was further confirmed to have a large incisional hernia in the midline of the abdominal wall, including small bowel collaterals, jejunum, mesentery, ascending colon, and transverse colon.
CT: large incisional hernia in the midline of the abdominal wall, including small intestinal collaterals, jejunum, mesentery, ascending colon, and transverse colon
II. Treatment history
I explained to the patient that although the skin and subcutaneous fat layer on the surface of the cesarean incision had healed, the fascial layer was split and the internal organs and tissues were herniated outward under intra-abdominal pressure, and that the incisional hernia could not heal spontaneously and should be treated surgically in a timely manner. After anesthesia and disinfection, incisional hernia repair was performed. The junction of skin and scar connective tissue was incised to reveal the outer layer of fibrous connective tissue covering the incisional hernia, the connective tissue around the hernia sac was fully separated, the hernia contents were returned to the abdominal cavity, and the operation was completed by suturing the rectus abdominis muscle and peritoneum with no adhesions and injuries to the intra-abdominal organs, and finally the subcutaneous tissue and skin were sutured. After surgical treatment, cefixime granules were given for anti-inflammatory and anti-infection treatment. The patient was given 7 days after hospitalization and discharged to recuperate at home, and the wound was changed and disinfected at regular intervals to avoid infection from water and to reduce various factors that increase intra-abdominal pressure so as not to affect wound healing.
III. Treatment effect
The patient was rechecked and stitches were removed 8 days after surgery, no wound infection was found, and the wound was in good condition.
IV. Notes
We are glad that the patient was discharged from the hospital after treatment, but we still need to remind the patient to pay attention to the following matters in daily life.
1. Pay attention to a light and easily digestible diet after surgery. You can gradually transition from a liquid diet to a semi-liquid diet, and then slowly return to a normal diet. After a normal diet, try to focus on high-quality protein and vitamin foods, such as milk, eggs, fish, meat, fresh vegetables, fruits, etc.
2, keep the bowels open, avoid constipation, constipation will increase intra-abdominal pressure, thus affecting the healing of the incision.
3, to pay attention to warmth after surgery, to avoid a violent cough caused by a cold, which can increase abdominal pressure.
4. Pay attention to the dryness and hygiene of the incision and change the medication on time to avoid infection.
5.Avoid strenuous exercise and heavy lifting in the short term after surgery, so as not to cause wound collapse and bleeding.
V. Personal insight
The main causes of incisional hernia are postoperative incisional infection and sudden increase in intra-abdominal pressure. Therefore, after abdominal surgery, patients should be reminded to avoid relevant precipitating factors as much as possible to reduce the occurrence of incisional hernia and to raise awareness of incisional hernia. Due to the presence of intra-abdominal pressure, incisional hernia does not heal spontaneously after occurrence and will worsen with age. Therefore, once incisional hernia is detected, it should receive timely treatment and surgery is the only curable means.