Herniated gravid uterus through an incisional hernia treated with the component separation technique

Abdominal wall hernia and pregnancy: a systematic review

PURPOSE

There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy.

METHODS

A literature search was undertaken in PubMed and Embase in combination with a cross-reference search of eligible papers.

RESULTS

We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported in 102 patients without major complications.

CONCLUSIONS

The literature on abdominal wall hernia and pregnancy is sparse. Abdominal wall hernia repair with suture or mesh may cause pain in the last trimester of a subsequent pregnancy. Hernia repair in conjunction with cesarean section appear as the optimal treatment of a pregnant patient with a symptomatic abdominal wall hernia.

Gravid uterus in neglected incisional hernia with skin defect-a clinical challenge

Incisional hernia during pregnancy with whole of gravid uterus as the content of the hernia sac is a rare occurrence. When such hernia is associated with skin defect over the sac, the management gets complicated. Very few such cases are reported in the literature. There is no consensus on the management of these cases in the available literature. Here, we are reporting two such cases managed in different ways and reviewed the literature.

LEVEL OF EVIDENCE

Level V, Clinical cases.

Herniated near-term pregnancy through an incisional hernia treated with polypropylene mesh: A case report

The management of a large incisional hernia amidst gravid uterus in its sac is a very challenging obstetric entity. Because of the uncommonness of this entity, there has not been any evidence-based guideline regarding the optimal mode of treatment and so treatment is largely individualised. We present the case of a 32-year-old booked G7P6+0 Nigerian woman with two living children who was already booked for elective repeat lower segment Caesarean section (CS) and 'Caesarean' herniorrhaphy at 38 weeks of gestation but only to present at 36-weeks gestation with a 4-hour history of labour pains. She had an emergency lower segment CS 2 years earlier due to obstructed labour but the CS was complicated by wound infection. Examination revealed gravid uterus that herniated through the incisional hernia. She subsequently had emergency lower segment CS with the repair of the hernia with polypropylene mesh. She had uneventful post-operative recovery. Herniated uterus of near-term pregnancy through an incisional hernia has not been reported in our hospital. As in our case, triumphant management required brave but multidisciplinary approach and currently there are emerging management options such as the use of mesh and laparoscopic technique.