Abstract

Dr. Saiprasad B. Kottawar*, Dr. Rashmi A. Kale

ABSTRACT

Introduction: Obstructed incisional hernia is a potentially serious complication of previous abdominal surgery and requires timely assessment and appropriate surgical management. The presence of multiple fascial defects and dense intra-abdominal adhesions can make emergency exploration technically challenging and increases the risk of bowel injury. The use of prosthetic mesh in emergency hernia repair requires careful assessment of bowel viability and the degree of contamination. Case Presentation: A 46-year-old female presented with acute-onset lower abdominal pain and a tender, irreducible swelling at the site of a previous operative scar following tubal ligation approximately 10 years earlier. Ultrasonography demonstrated a bowel-containing incisional hernia with features suggestive of obstruction. The patient was hemodynamically stable, with no clinical evidence of generalized peritonitis. Intervention: Emergency surgical exploration was performed. Multiple fascial defects with dense adhesions between the bowel loops and anterior abdominal wall were identified. Careful adhesiolysis was performed, and the obstructed small-bowel loops were reduced after confirming viability. There was no gangrene, perforation, or gross contamination. The multiple defects were delineated and repaired using tension-free polypropylene mesh with adequate overlap. Outcome: The postoperative recovery was uneventful. The patient tolerated gradual reintroduction of oral intake and was mobilized appropriately. No surgical-site infection, mesh-related complication, or clinically significant seroma was observed during the reported postoperative period. The patient was discharged in stable condition. At follow-up, she remained asymptomatic without recurrent swelling or obstructive symptoms. Follow-up duration: 6 weeks. Conclusion: Emergency mesh repair may be considered in carefully selected patients with obstructed incisional hernia when the bowel remains viable and the operative field is suitable for prosthetic mesh placement. Identification of all fascial defects, meticulous adhesiolysis, assessment of bowel viability, adequate mesh overlap, and tension-free fixation are important for successful repair.