Incarcerated pre-sternal epigastric hernia causing closed-loop large bowel obstruction

Title : Incarcerated pre-sternal epigastric hernia causing closed-loop large bowel obstruction

Abstract:

Background:
• Epigastric hernias typically contain fat/omentum
• Rarely migrate into pre-sternal region
• Bowel involvement is rare, large bowl strangulation extremely uncommon
• Emergency laparotomy = higher morbidity / mortality rates, especially in elderly patients 

Case: 
• 88M frail gentleman with multiple comorbidities
• PC: abdominal pain, distension, nausea, redcued PO intake
• OE: abdominal distension, irreducible epigastric mass

Intra-operative Findings & Management:
• Large bowel herniation via epigastric hernia into pre-sternal region causing closed loop LBO
• Appendicotomy performed to aid decompression and facilitate safe reduction of large bowel from abnormal position avoiding large bowel resection
• Hernia defect repaired - primary suture repair ??mesh

Key Learning Points:
• Interesting case of abnormally located epigastric hernia and use of venting appendicotomy
• Consider use of appendicotomy for decompression in LBO to potentially avoid bowel resection and reduce morbidity in high risk patients

Biography:

Sarah Stevenson is a second-year Core Surgical Trainee with full MRCS qualification and a strong interest in General Surgery, particularly in the development and optimisation of ambulatory surgical care. she passionate about improving patient pathways, enhancing clinical efficiency, and promoting high-quality multidisciplinary collaboration. Her work has focused on quality improvement initiatives aimed at streamlining investigations and improving patient understanding through innovative approaches such as digital education tools.  She committed to delivering safe, patient-centred care while continuing to develop her surgical skills, academic interests, and leadership experience within a dynamic clinical environment.