Giant incisional hernia with a protruding pregnant uterus and overlying thinned-out ulcerated skin: A case report and review of literature
Main Article Content
Keywords
Giant Incisional Hernia, Pregnant Protruding Uterus, Ulcerated Thinned Skin, Port Harcourt, Nigeria.
Abstract
Incisional hernias are part of the workload of the General Surgeon, for which there are known risk factors, and surgical repair can be challenging. The aim of this study was to report an unusual presentation of a giant incisional hernia with a protruding pregnant uterus and thinned-out ulcerated skin, seen at the Rivers State University Teaching Hospital in Port Harcourt in the year 2024.A 38-year-old female, Gravida 2 Para1, who presented with protrusion of the lower abdomen, pain, and bleeding from a sore at the lower abdomen. She had a previous Caesarean section complicated by wound sepsis and prolonged hospital stay. Significant examination findings included enlarged (gravid) pendulous abdomen, a broad sub-umbilical mid-line scar, an overlying area of shallow ulcer (10cm by 6cm), surrounding hyperpigmented skin, and tenderness at the sub-umbilical area. There was a protruding mass that measured 20cm by 14cm at presentation, which increased in size, extending to the mid-thigh at the time of surgery. She had multi-specialty care that ended with an elective repeat Caesarean section, hernia repair, abdominoplasty, and the outcome of care was satisfactory. A complicated giant incisional hernia is reported in a patient with gestational diabetes mellitus. A successful outcome was guaranteed by prolonged admission and multidisciplinary care.
References
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25. Ali WM, Alim SS, Rab AZU, Ali I, Ahmad M. Spontaneous rupture of incisional hernia in a 7 month concealed pregnancy: a rare case report. International Journal of Surgery. 2020;4(1):451-453.
26. Sahu L, Bupathy A. Evisceration of pregnant uterus through the incisional hernia site. Journal of Obstetrics and Gynaecology Research. 2006 Jun;32(3):338-340.
27. Otolorin E, Okubanjo A. Advanced extra-uterine pregnancy within a huge incisional hernia. Journal of Obstetrics and Gynaecology. 1983;4(1):25-. doi.org/10.3109/01443618309071222
28. Dare F, Makinde O, Lawal O. Gravid uterus in an anterior abdominal wall hernia of a Nigerian woman. International Journal of Gynecology & Obstetrics. 1990;32(4):377-379.
29. Uchenna EG, Chukwuneme OB, Ejike ES, Mbanefo OP, Benjamin ET. Herniated near-term pregnancy through an incisional hernia treated with polypropylene mesh: A case report. Nigerian Medical Journal. 2014;55(3):271-273.
30. Agaja S, Ehalaiye B. Full-term pregnancy in an incisional hernia-a case report. Nigerian Journal of Clinical Practice. 2007;10(3):252-254.
31. Makama JG, Odigie V, Yusufu L, Ameh N. Herniated gravid uterus: clinical course and result of treatment. Annals of African Medicine. 2007;6(4):197-199.
32. Jombo S, Emejulu C, Obi R, Onwusulu D, Iloh A, Ilikannu S. Incisional hernia in pregnancy: a silent but potential fatality–case report. AJSRR. 2020;3:1-8.
33. Komolafe J, Oyeniran O. Extra abdominal, intrauterine pregnancy. Journal of obstetrics and gynaecology. 2006;26(3): 265-266.
34. Dasgupta S. Incisional hernia in pregnancy. International Journal of User-Driven Healthcare (IJUDH). 2012 Oct 1;2(4): 60-62.
35. Ahmed A, Stephen G, Ukwenya Y. Spontaneous rupture of umbilical hernia in pregnancy: a case report. Oman Medical Journal. 2011;26(4):285.
36. Akuabia N, Iheukwumere E, Athanatius O. Incisional scar evisceration of fallopian tube in a pregnant woman. Tropical Journal of Obstetrics and Gynaecology. 2015;32(1):167-70.
37. Iwo-Amah RS, Ijah RFO, Tamunokuro TN, Ocheche U. Large umbilical hernia complicating huge uterine fibroid: Case report in a tertiary hospital in Port Harcourt, Nigeria. World Journal of Advanced Research and Reviews. 2023;17(1):285-90.
38. Airede L, Nnadi D, Gana M, Legbo J. Rupture of a gravid uterus within an umbilical hernia. CME: Your SA Journal of CPD. 2007;25(6):290-2.
39. Adesiyun AG, Ameh N, Umar-Sullyman H, Avidime S, Alkali G, Bakari F, et al. Term gravid uterus as a content of congenital umbilical hernia—a complication in a multigravida that presented in labour. Case Reports in Clinical Medicine. 2015;4(01):6.
40. Ray-Offor E, Okeke CJ. Elective Repair of Adult Abdominal Wall Hernia: A Nigerian Tertiary Hospital Experience. European Journal of Medical and Health Sciences. 2021;3(1):68-72.
41. Ijah R, Wakama I, Elenwo S. Spectrum of General Surgery Disease Conditions at The Rivers State University Teaching: A Six-Year Study. Clin Case Rep Open Access. 2022;5(2):216.
42. Abur PP, Daniyan M, Nwabuoku SE, Yusufu LM, Odigie VI. Changing pattern of adult external abdominal hernias in Zaria. Port Harcourt Medical Journal. 2020;14(1):19-22.
43. Ekwunife CN, Enendu SE, Ngaikedi CN, Duru ON, Ugo V, Ekperechukwu CA. Frequency of Abdominal Wall Hernias: A Nigerian Hospital Experience. European Journal of Medical and Health Sciences. 2023;5(6):25-7.
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45. Coco D, Leanza S. Giant Incisional Hernia: Which Treatment? Case Report and Review of Literature. Open Access Macedonian Journal of Medical Sciences. 2020;8(C):23-6.
46. Roofthooft E, Rawal N, Van de Velde M. Current status of the combined spinal-epidural technique in obstetrics and surgery. Best Practice & Research Clinical Anaesthesiology. 2023;37(2):189-98.
47. Rehman H-u, Mohammed K. Perioperative management of diabetic patients. Current surgery. 2003;60(6):607-11.
48. Karunarathna I, Kusumarathna K, Jayathilaka P, Rathnayake B, Gunathilake S, Senarathna R, et al. Comprehensive Management of Diabetes Mellitus in the Perioperative Setting: An Anesthesia Perspective. Uva Clinical Lab Retrieved from ResearchGate. 2024.
49. Hall G. The anaesthetic modification of the endocrine and metabolic response to surgery. Annals of the Royal College of Surgeons of England. 1985;67(1):25.
50. Wolf A, Eyres R, Laussen P, Edwards J, Stanley I, Rowe P, et al. Effect of extradural analgesia on stress responses to abdominal surgery in infant. BJA: British Journal of Anaesthesia. 1993;70(6):654-60.
51. McAnulty G, Robertshaw H, Hall G. Anaesthetic management of patients with diabetes mellitus. British journal of anaesthesia. 2000;85(1):80-90.
52. Raucoules-Aime M, Labib Y, Levraut J, Gastaud P, Dolisi C, Grimaud D. Use of iv insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery. British journal of anaesthesia. 1996;76(2):198-202.
53. Knight KM, King GE, Palcsey SL, Suda A, Liang R, Moalli PA. Mesh deformation: A mechanism underlying polypropylene prolapse mesh complications in vivo. Acta biomaterialia. 2022;148:323-35.
54. Oma E, Jensen K, Jorgensen L, Bisgaard T. Incisional hernia repair in women of childbearing age: A nationwide propensity-score matched study. Scandinavian Journal of Surgery. 2020;109(4):295-300.
2. Kohler A, Lavanchy JL, Lenoir U, Kurmann A, Candinas D, Beldi G. Effectiveness of prophylactic intraperitoneal mesh implantation for prevention of incisional hernia in patients undergoing open abdominal surgery: a randomized clinical trial. JAMA surgery. 2019;154(2):109-115.
3. Sneiders D, Yurtkap Y, Kroese LF, Kleinrensink GJ, Lange JF, Gillion JF, et al. Risk factors for incarceration in patients with primary abdominal wall and incisional hernias: a prospective study in 4472 patients. World journal of surgery. 2019;43(8):1906-1913.
4. Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, et al. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbeck's Archives of Surgery. 2024;409(1):1-26.
5. Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, et al. Midline incisional hernia guidelines: the European Hernia Society. British Journal of Surgery. 2023;110(12):1732-1768.
6. Sá B, Barbosa E, Morais JP, Fonseca T, Gouveia AM, Carneiro S. Incidence Of Incisional Hernia After Laparotomy. Portuguese Journal of Surgery. 2024(57):101-113.
7. Eriksson A, Rosenberg J, Bisgaard T. Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia. 2014;18:31-38.
8. Huatuco RMP, Pinsak AE, Palencia R. Complex giant incisional hernia repair with intraperitoneal mesh: A case report. Annals of Medicine and Surgery. 2021;65. doi.org/10.1016/j.amsu.2021.102340
9. Speranzini MB, Deutsch CR. Giant incisional hernias. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2010;23:280-286.
10. Deerenberg E, Timmermans L, Hogerzeil D, Slieker J, Eilers P, Jeekel J, et al. A systematic review of the surgical treatment of large incisional hernia. Hernia. 2015;19:89-101.
11. Passot G, Villeneuve L, Sabbagh C, Renard Y, Regimbeau J-M, Verhaeghe P, et al. Definition of giant ventral hernias: development of standardization through a practice survey. International journal of surgery. 2016;28:136-140.
12. Bhardwaj P, Huayllani MT, Olson MA, Janis JE. Year-over-year ventral hernia recurrence rates and risk factors. JAMA surgery. 2024;159(6):651–658. doi:10.1001/jamasurg.2024.0233
13. Kenington JC, Pellino G, Iqbal MR, Ahmed N, Halahakoon VC, Zaborowski AM, et al. Guidelines on general surgical emergencies in pregnancy. British Journal of Surgery. 2024;111(3):znae051. https://doi.org/10.1093/bjs/znae051
14. Jensen K, Henriksen N, Jorgensen L. Abdominal wall hernia and pregnancy: a systematic review. Hernia. 2015;19:689-696.
15. Henriksen N, Kaufmann R, Simons M, Berrevoet F, East B, Fischer J, et al. EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS open. 2020;4(2):342-353.
16. Augustin G, Matosevic P, Kekez T, Majerovic M, Delmis J. Abdominal hernias in pregnancy. J Obstet Gynaecol Res. 2008;35(2):203-211.
17. Dias SJT, Gobishangar S, Heerthikan K. Successful management of strangulated incisional hernia in pregnancy—a case report. International Journal of Surgery Case Reports. 2023;110:108745. https://doi.org/10.1016/j.ijscr.2023.108745
18. Emegoakor C, Dike E, Emegoakor F. Unusual complications of incisional hernia. Annals of medical and health sciences research. 2014;4(6):971-974.
19. Palazzo F, Ragazzi S, Ferrara D, Piazza D. Herniated gravid uterus through an incisional hernia treated with the component separation technique. Hernia. 2010;14(1):101-104.
20. Saha PK, Rohilla M, Prasad G, Dhaliwal LK, Gupta I. Herniation of gravid uterus: report of 2 cases and review of literature. Medscape General Medicine. 2006;8(4):14.
21. Rathi A, Gupta A. Term uterus in complicated ventral hernia. J Postgrad Gynecol Obstet. 2014;1:3.
22. Banerjee N, Deka D, Sinha A, Prasrad R, Takkar D. Gravid uterus in an incisional hernia. Journal of Obstetrics and Gynaecology Research. 2001;27(2):77-79.
23. Suleman K, Wokoh U, Iyer P, Yoong W. Pregnancy complicated by massive incisional hernia: challenges in management and review of literature. BMJ Case Reports CP. 2023;16(12):e254637. doi.org/10.1136/bcr-2023-254637
24. Hcini N, Chelli D, Boudaya F, Amraoui J, Makhlouf M, Sfar E. Herniated gravid uterus growing in an incisional hernia: study of three cases. Hernia. 2016;20(4):633-636.
25. Ali WM, Alim SS, Rab AZU, Ali I, Ahmad M. Spontaneous rupture of incisional hernia in a 7 month concealed pregnancy: a rare case report. International Journal of Surgery. 2020;4(1):451-453.
26. Sahu L, Bupathy A. Evisceration of pregnant uterus through the incisional hernia site. Journal of Obstetrics and Gynaecology Research. 2006 Jun;32(3):338-340.
27. Otolorin E, Okubanjo A. Advanced extra-uterine pregnancy within a huge incisional hernia. Journal of Obstetrics and Gynaecology. 1983;4(1):25-. doi.org/10.3109/01443618309071222
28. Dare F, Makinde O, Lawal O. Gravid uterus in an anterior abdominal wall hernia of a Nigerian woman. International Journal of Gynecology & Obstetrics. 1990;32(4):377-379.
29. Uchenna EG, Chukwuneme OB, Ejike ES, Mbanefo OP, Benjamin ET. Herniated near-term pregnancy through an incisional hernia treated with polypropylene mesh: A case report. Nigerian Medical Journal. 2014;55(3):271-273.
30. Agaja S, Ehalaiye B. Full-term pregnancy in an incisional hernia-a case report. Nigerian Journal of Clinical Practice. 2007;10(3):252-254.
31. Makama JG, Odigie V, Yusufu L, Ameh N. Herniated gravid uterus: clinical course and result of treatment. Annals of African Medicine. 2007;6(4):197-199.
32. Jombo S, Emejulu C, Obi R, Onwusulu D, Iloh A, Ilikannu S. Incisional hernia in pregnancy: a silent but potential fatality–case report. AJSRR. 2020;3:1-8.
33. Komolafe J, Oyeniran O. Extra abdominal, intrauterine pregnancy. Journal of obstetrics and gynaecology. 2006;26(3): 265-266.
34. Dasgupta S. Incisional hernia in pregnancy. International Journal of User-Driven Healthcare (IJUDH). 2012 Oct 1;2(4): 60-62.
35. Ahmed A, Stephen G, Ukwenya Y. Spontaneous rupture of umbilical hernia in pregnancy: a case report. Oman Medical Journal. 2011;26(4):285.
36. Akuabia N, Iheukwumere E, Athanatius O. Incisional scar evisceration of fallopian tube in a pregnant woman. Tropical Journal of Obstetrics and Gynaecology. 2015;32(1):167-70.
37. Iwo-Amah RS, Ijah RFO, Tamunokuro TN, Ocheche U. Large umbilical hernia complicating huge uterine fibroid: Case report in a tertiary hospital in Port Harcourt, Nigeria. World Journal of Advanced Research and Reviews. 2023;17(1):285-90.
38. Airede L, Nnadi D, Gana M, Legbo J. Rupture of a gravid uterus within an umbilical hernia. CME: Your SA Journal of CPD. 2007;25(6):290-2.
39. Adesiyun AG, Ameh N, Umar-Sullyman H, Avidime S, Alkali G, Bakari F, et al. Term gravid uterus as a content of congenital umbilical hernia—a complication in a multigravida that presented in labour. Case Reports in Clinical Medicine. 2015;4(01):6.
40. Ray-Offor E, Okeke CJ. Elective Repair of Adult Abdominal Wall Hernia: A Nigerian Tertiary Hospital Experience. European Journal of Medical and Health Sciences. 2021;3(1):68-72.
41. Ijah R, Wakama I, Elenwo S. Spectrum of General Surgery Disease Conditions at The Rivers State University Teaching: A Six-Year Study. Clin Case Rep Open Access. 2022;5(2):216.
42. Abur PP, Daniyan M, Nwabuoku SE, Yusufu LM, Odigie VI. Changing pattern of adult external abdominal hernias in Zaria. Port Harcourt Medical Journal. 2020;14(1):19-22.
43. Ekwunife CN, Enendu SE, Ngaikedi CN, Duru ON, Ugo V, Ekperechukwu CA. Frequency of Abdominal Wall Hernias: A Nigerian Hospital Experience. European Journal of Medical and Health Sciences. 2023;5(6):25-7.
44. from Criminal GPT. Book of Abstracts for the 11th Congress of the Association of Surgeons of Nigeria, Yenagoa, July 2015. Nigerian Journal of Surgery Jan‑Jun. 2016;22(1).
45. Coco D, Leanza S. Giant Incisional Hernia: Which Treatment? Case Report and Review of Literature. Open Access Macedonian Journal of Medical Sciences. 2020;8(C):23-6.
46. Roofthooft E, Rawal N, Van de Velde M. Current status of the combined spinal-epidural technique in obstetrics and surgery. Best Practice & Research Clinical Anaesthesiology. 2023;37(2):189-98.
47. Rehman H-u, Mohammed K. Perioperative management of diabetic patients. Current surgery. 2003;60(6):607-11.
48. Karunarathna I, Kusumarathna K, Jayathilaka P, Rathnayake B, Gunathilake S, Senarathna R, et al. Comprehensive Management of Diabetes Mellitus in the Perioperative Setting: An Anesthesia Perspective. Uva Clinical Lab Retrieved from ResearchGate. 2024.
49. Hall G. The anaesthetic modification of the endocrine and metabolic response to surgery. Annals of the Royal College of Surgeons of England. 1985;67(1):25.
50. Wolf A, Eyres R, Laussen P, Edwards J, Stanley I, Rowe P, et al. Effect of extradural analgesia on stress responses to abdominal surgery in infant. BJA: British Journal of Anaesthesia. 1993;70(6):654-60.
51. McAnulty G, Robertshaw H, Hall G. Anaesthetic management of patients with diabetes mellitus. British journal of anaesthesia. 2000;85(1):80-90.
52. Raucoules-Aime M, Labib Y, Levraut J, Gastaud P, Dolisi C, Grimaud D. Use of iv insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery. British journal of anaesthesia. 1996;76(2):198-202.
53. Knight KM, King GE, Palcsey SL, Suda A, Liang R, Moalli PA. Mesh deformation: A mechanism underlying polypropylene prolapse mesh complications in vivo. Acta biomaterialia. 2022;148:323-35.
54. Oma E, Jensen K, Jorgensen L, Bisgaard T. Incisional hernia repair in women of childbearing age: A nationwide propensity-score matched study. Scandinavian Journal of Surgery. 2020;109(4):295-300.
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Sep 19, 2025
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Ijah, R. F. O. A., Kua, P. L., Ngeri, B., Ela, G. M., Udeme, N. I., & Kyamummi, I. (2025). Giant incisional hernia with a protruding pregnant uterus and overlying thinned-out ulcerated skin: A case report and review of literature. Nigerian Medical Journal, 66(3), 1231–1240. https://doi.org/10.71480/nmj.v66i3.702
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Author Biography
Irene Kyamummi, Department of Anaesthesiology (On Post Fellowship Program in Obstetric Anaesthesia, Sponsored by the World Federation of Societies of Anaesthesiologists), Rivers State University Teaching Hospital, Port Harcourt, Nigeria.
Consultant Anaesthesiologist