A Case Report of Incarcerated Umbilical Hernia Complicated by Ascites in a Tertiary Facility in the Eastlands Area of Nairobi, Kenya

Abstract

Umbilical hernias are uncommon in the adult population, and when they occur, they are the acquired type and present with complications such as strangulation and incarceration. Such a hernia presents a surgical dilemma, particularly because of the accompanying comorbidities, such as conditions that increase intrabdominal pressure, such as chronic cough, liver cirrhosis with uncontrolled ascites, and pregnancy, that put the patients at surgical risk. Besides, many of the patients report to the hospital late when the umbilical hernia has complications, precluding optimisation for elective surgical hernia repair. We are presenting a case of a 50-year-old male patient known to have chronic liver disease and uncontrolled ascites who presented to the hospital with a painful swelling at the umbilical area. The swelling was asymptomatic for the past 2 years but developed pain for 2 days associated with a change of colour of the overlying skin.  A diagnosis of a non-reducible strangulated umbilical hernia was made clinically and confirmed sonographically, where aperistatlitic intestinal loops were observed. Open surgical repair was performed, where a necrotic jejunal loop measuring 20 cm was resected, and an end-to-end anastomosis of the viable jejunal loop was done. The hernial sac was removed, and the abdominal wall defect was closed using non-absorbable suture. This case report presents real-world experience in the provision of hernia surgery services in a tertiary facility in a resource-limited setting. The study describes both patient-related and provider-related factors that influence surgical care-seeking behaviour and decision-making for elective surgical hernia repair. Healthcare service providers should understand and appreciate the significance of these factors and how they affect the day-to-day care of surgical patients.