A Giant Primary Supraumbilical Hernia Coexisting with a Giant Lipoma: A Case Report
Jerry Godfrey Makama and Stephen Ekundayo Garba
World Journal of Medical and Surgical Case Reports 2014, 3:5
A ventral hernia is a hernia involving the anterior abdominal wall. It is further divided into primary abdominal wall hernias (those hernias that occur spontaneously in the anterior abdominal wall with no previous history of abdominal wall surgery or trauma) from incisional hernias (occurring from a weak scar in the anterior abdominal wall). Giant ventral hernias are considered in cases where the hernia orifice is greater than 10 cm. Giant lipoma are considered when weight is <5kg.
A 30year-old female was admitted in the surgical ward with a three year history of progressive, painless abdominal swelling above the umbilicus. The swelling does not disappear, especially, when lying supine. Examination revealed an obese woman, with a BMI of 40.1, well hydrated and pink. Her temperature was 36.8ºC. The cardiopulmonary status was normal with a pulse rate of 89/min, blood pressure of 110/78mmHg and the lung fields were clear. There was a swelling around the umbilicus with no visible peristalsis; no visible and palpable cough impulse. The swelling was soft with no area of tenderness; however, it was difficult to reduce. Digital rectal examination was normal. Haemogram was 10.1g/dl. Abdomino-pelvic ultrasound scan of the abdomen reported loculated fluid and some gas levels suggestive of a huge mass of various loops of bowel adjourning fatty tissue in lobules in the anterior abdominal wall. Intra-operatively, the abnormalities found were an invagination of loops of jejunum through a defect and fatty tissue (lipoma) in the anterior abdominal wall. Following excision of the lipoma and successful manual reduction, a wall defect of about 11.8cm was found. The defect was primarily repaired with a non absorbable Nylon suture. Patient did well postoperatively and was discharged after 10 days. The patient has been entirely free of symptoms since six months of operation.
Careful preoperative preparation, operative technique, and postoperative care are required for successful management of giant primary supra-umbilical hernias coexisting with a lipoma
Giant, Hernia, Lipoma, Ventral