Non-traumatic hernia of the lateral abdominal wall in a patient infected with the human immunodeficiency virus

HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome

Introduction and importance

Surgical site infection (SSI) is an inevitable occurrence in bowel perforation with faecal soiled hernia wound(s) especially in retroviral patients. Unfortunately, the increased antibiotics and wound care demands do not prevent delayed healing, increased risk of hernia recurrence, or multiple surgeries to control the infection. The standard open or endo-laparoscopic Mesh repairs are either deferred or avoided with alternative tissue-based hernia repairs after bowel surgery. The reported success of open tissue-based repairs remains mixed. Nylon monofilament that have been used in infected wounds was chosen for the patient in anticipation of wound infection.

Case presentation

A 48-year-old man presented with a 7-days complicated hernia at the emergency unit, Margaret Marquart Catholic Hospital. Clinical examination revealed signs of shock, intestinal obstruction, and peritonism, laboratory investigation was remarkable of anaemia, septicaemia, deranged renal function, and positive retroviral test. He had concurrent right hemicolectomy and nylon darn after optimisation. The outcome we evaluated after surgery included postoperative pain, scrotal collection, anastomotic breakdown, postoperative analgesic use, wounds infection, prolonged hospital stays, recurrence, and the need for a second surgery. Though he developed prolonged deep SSI, he has intact hernia repair after 6-years.

Clinical discussion

The postoperative critical clinical events presented in this case were unexpected but might have been precipitated by his retroviral status. Thus, a weight loss of over 13 kg within 2 weeks was highly unusual. Furthermore, the positive retroviral status couple with the perforated caecum and soiled peritoneum was the cause of the surgical site infection.

Conclusion

Nylon darning in a retro-positive patient developing prolonged SSI appeared beneficial. It should be considered in patients with anticipated long period wound infection.

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Surgical site infection is a challenge in hernias with perforated viscus after repair.

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Current standard modalities of hernia repairs are used in such patient's infection are not anticipated.

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Patient with retroviral infection and wound contamination requires a different approach to ensure the intact repair.

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Nylon darn, one of the methods was used with success.

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Our patient with a prolonged infection after surgery and a 5-year post-repair success are a first of the kind reported.