Key points are not available for this paper at this time.
Abstract Case Presentation A 52-year-old man with recurrent incisional hernia and para-stomal hernia presented to another hospital over the weekend due to abdominal pain, repeated vomiting, and a non-functional stoma. Enlargement of the scrotal region was noted, reflecting a pattern of similar admissions in the past. He was transferred to our unit for potential early surgery, having previously sought care for abdominal wall reconstructions at our center, including a scheduled preoperative Botox treatment. The patient's medical history involved a 2017 emergency laparotomy for perforated diverticular disease resulting in a Hartmann procedure, and subsequent repairs for incisional and right groin hernias in 2019. The latter surgery led to wound dehiscence, prompting emergency intervention with small bowel resection and mesh removal. In 2023, the patient underwent removal of an infected right groin mesh, leaving behind a draining sinus. Hernia-related risks included ex-smoking, a reduction in BMI from 39 to 34, and diabetes. Management and Outcomes The patient's admission bloodwork showed slightly elevated inflammatory markers. A CT scan revealed a complex hernia scenario with distended small bowel and pockets of free fluid, suggesting at-risk bowel. The intraoperative procedure involved scar removal, adhesiolysis, and hernia repair, with complications such as dusky bowel appearance and fluid accumulation in the scrotum. The surgical approach included bilateral retro rectus with TAR, lateralization of the stoma, and mesh placement. Discussion In the post-operative period, the patient experienced challenges, including five days of intubation without muscle relaxation, abdominal pressure monitoring, and renal function decline requiring hemofiltration. Stoma function resumed on the third post-operative day, and the patient transitioned from total parenteral nutrition (TPN) to a mix of TPN and enteral feeding.
Alabbasi et al. (Wed,) studied this question.