A Case of Ventral Hernia with Incarcerated Necrosis at Transverse Colon

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  • 横行結腸が嵌頓壊死をきたした腹壁瘢痕ヘルニアの1例

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Abstract

An 80-year-old woman with abdominal pain and a sensation of distension feeling saw a doctor after three days from the start of the symptoms. Her previous medical history included an appendectomy. Under the diagnosis of incarceration of an abdominal incisional hernia, she was referred to our hospital for emergency surgery on the 4th day after the start of the symptoms. Contrast enhanced CT demonstrated prolapse of a part of the transverse colon with incarceration from a hernia orifice of 3 cm diameter, and inflammatory findings were confirmed around the area. The patient underwent midline laparotomy the same day. The mid portion of the transverse colon was incarcerated and necrosed within the hernial sac. We therefore performed a right hemicolectomy with debridement of the inside the hernia sac and simple closure of the hernia orifice. An open wound was created with a transverse incision on the right lower quadrant for subcutaneous drainage. In this severely infected case, to manage the patient's condition and the open wound, daily irrigation of the wound was repeatedly applied. The midline incision, however, was infected and disrupted. Therefore, daily irrigation was applied to the incision as well, which closed on the 47th postoperative day. No recurrence has been found in two years.

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