Journal of Acute Care Surgery

Delayed diagnosis and successful mesh repair of a Grynfeltt-Lesshaft lumbar hernia in a 65-year-old man in India: a case report: Mohan Lal, Parikshit Chandawat; J Acute Care Surg 2025;15(3):139-142. Published online November 30, 2025; DOI: https://doi.org/10.17479/jacs.2024.0020

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The literature has described approximately 300 cases of lumbar hernia. Because of its rarity, the condition is often misdiagnosed, leading to delayed treatment. We report the case of a 65-year-old man who had complained for 5 years of a lump in his left lumbar region. There was no history of prior trauma or surgery. The mass gradually increased in size and was associated with vague dragging pain. The diagnosis of Grynfeltt-Lesshaft lumbar hernia was made based on clinical suspicion and ultrasound findings. The patient underwent open sublay mesh repair and recovered without complications. This case is noteworthy for the 5-year delay in diagnosis and management without computed tomography or magnetic resonance imaging, underscoring the role of high clinical suspicion and ultrasound-based diagnosis in resource-limited settings. Although rare, lumbar hernia should be considered in the differential diagnosis of a lumbar mass. Early diagnosis with ultrasound, contrast-enhanced computed tomography, or magnetic resonance imaging can help prevent complications. This case raises awareness of lumbar hernia and outlines available surgical options for treatment.

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Drain-site hernia causing small-bowel strangulation in a 57-year-old man with gastric cancer 6 months after gastrectomy in India: a case report: Handilu Kath Rengma, Durgesh Ommi, Temsula Alinger; J Acute Care Surg 2025;15(3):170-173. Published online November 27, 2025; DOI: https://doi.org/10.17479/jacs.2025.0029

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Drain‑site hernias are an uncommon but potentially life‑threatening complication following abdominal surgery. We report the case of a 57‑year‑old man with a prior distal gastrectomy who developed acute intestinal obstruction and bowel gangrene due to herniation through a previous drain site. For several months he had a persistent, nontender swelling in the same region that was assumed to be a seroma. He later presented with sudden pain and obstructive symptoms; imaging revealed a small‑bowel loop herniating through an abdominal wall defect. Emergency laparotomy confirmed a strangulated hernia containing nonviable bowel, which was resected. Fascial closure was performed using interrupted sutures. This case highlights the importance of recognizing delayed complications at drain sites and underlines the value of early imaging. Careful drain management, including use of the smallest effective calibre and timely removal, remains critical in preventing such rare but serious postoperative events.

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Trauma

Traumatic abdominal wall hernia associated with a cow horn in Korea: a case report: Hwajin Shin, Chan Yong Park; J Acute Care Surg 2025;15(2):82-85. Published online July 30, 2025; DOI: https://doi.org/10.17479/jacs.2025.0002

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The diagnosis and evaluation of traumatic abdominal wall hernia can be challenging because of its low incidence and nonspecific clinical presentation. Without a high index of clinical suspicion, the detection of traumatic abdominal wall hernia may be delayed. A 71-year-old female patient was struck in the lower abdomen by a cow horn and initially received only conservative management at a local clinic. However, her pain worsened despite conservative measures, and she developed a reducible bulging mass. Computed tomography revealed an abdominal wall defect with small bowel herniation. She was transferred to our hospital's emergency department, where urgent surgery was performed. A laparotomy was conducted to repair the abdominal wall defect and explore potential intra-abdominal injuries. The defect was successfully repaired, and the patient was discharged without complications on postoperative day 10.

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Emergency surgery

A Case of Preperitoneal Herniation of the Small Bowel Causing Intestinal Obstruction Following a Totally Extra Peritoneal Hernia Repair: Lasitha B Samarakoon, Samip Chandraprakash, Rolands Fernandes, Pradeep Basnyat; J Acute Care Surg 2022;12(3):138-141. Published online November 23, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.3.138

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Preperitoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. A 57-yearold male underwent a right inguinal hernia totally extra peritoneal repair on 20/10/2021. Initial recovery was uncomplicated but on post operative day 10, he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction with a possible transition point. An internal hernia was suspected and he was offered urgent diagnostic laparoscopy following counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. A small bowel runthrough did not reveal any pathological abnormalities. A presumptive diagnosis of a preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful postoperative recovery. An inadvertent breach in the peritoneum during a totally extra peritoneal repair can lead to preperitoneal herniation of the small bowel and intestinal obstruction postoperatively.

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Emergency surgery

Laparoscopic Tissue Repair of an Acutely Incarcerated Spigelian Hernia: Yagan Pillay, Rufaro Asefa; J Acute Care Surg 2021;11(1):36-38. Published online March 24, 2021; DOI: https://doi.org/10.17479/jacs.2021.1.36

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Spigelian hernias are a rare type of abdominal wall hernia. A weakness in the spigelian fascia causes abdominal contents to herniate between the abdominal muscle layers as an interparietal hernia. We present the case of a 72-year old woman with acute onset abdominal pain and distention. A computed tomography scan revealed an incarcerated spigelian hernia with small bowel obstruction. This necessitated an acute surgical intervention with a laparoscopic tissue repair. The case is unique as our patient had a large hernial neck measuring 4.8 centimeters, one of the largest in published literature. The laparoscopic tissue repair is outside the current norm for this type of hernial repair and remains a rare type of surgical herniorrhaphy. Laparoscopic ventral hernia repair in the acute setting should form part of the surgical skill set of acute care surgeons as borne out by the published literature and this case report.

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Emergency surgery

Early Posterior Rectus Sheath Hernia Recurrence After Open Incisional Hernia Repair with Retrorectus Mesh Placement: Grigoriy V. Klimovich, Randal Zhou, Kurt E. Roberts; J Acute Care Surg 2020;10(3):126-128. Published online November 20, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.3.126

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A 51-year-old female underwent recurrent open incisional hernia repair with retrorectus mesh placement. Early in the post-operative course, she developed a hernia reoccurrence secondary to breakdown of the staple line, at the level of the posterior rectus sheath, resulting in a small bowel obstruction. This hernia could not be felt upon physical examination but was detected by imaging. The patient was promptly taken to the operating room for laparoscopic reduction of the incarcerated loop of small intestine, along with laparoscopic repair of the posterior rectus sheath defect. It is critical for surgeons to recognize the possibility of a staple line breakdown at the level of posterior rectus sheath early on in the diagnosis which would prompt urgent surgical intervention in the setting of a bowel obstruction.

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Strangulated interstitial interparietal hernia following lower segment caesarean section: a case report
Celine Garrett, Ruwanthi Wijayawardana, David L Morris
Journal of Surgical Case Reports.2023;[Epub] CrossRef

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Emergency surgery

Short Bowel Syndrome from Strangulated Internal Hernia After Childbirth in a Patient With a History of Gastric Bypass Surgery: Case Report: Jisu Lee, Tae Sun Ha, Jeonghwi Choi, Yeonhwa Kwon, Zisun Kim; J Acute Care Surg 2020;10(3):118-122. Published online November 20, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.3.118

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Bariatric patients are at risk of diverse complications, such as bowel obstruction, internal hernia, and mesenteric thrombosis, which can result in massive small bowel resection with short bowel syndrome (SBS) as a consequence. In this study a case of an internal hernia after childbirth in a 36-year-old patient with a history of laparoscopic Roux-en-Y gastric bypass surgery is reported. An emergency laparotomy revealed an internal hernia in Petersen’s space with volvulus, causing extensive small bowel infarction and necrosis. SBS is a complicated multifaceted syndrome which requires a multidisciplinary approach, such as medical, nutritional, and pharmaceutical therapies, to optimize fluid and nutrient absorption over long-term monitoring and with revisions of the care plan. To reduce the morbidity and mortality associated with an internal hernia and volvulus, clinicians must be acutely aware of a potential SBS diagnosis and not delay surgical exploration, even if the vital signs, laboratory results, and imaging studies are normal.

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Emergency surgery, Procedure

Abdominal Wall Reconstruction with Component Separation: Eun Jeong Choi, Eun Key Kim; J Acute Care Surg 2018;8(2):43-50. Published online October 30, 2018; DOI: https://doi.org/10.17479/jacs.2018.8.2.43

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The principal goal of an abdominal wall reconstruction is to repair abdominal defects by restoring the continuity of the myofascial layer, providing functional structural support, and minimizing the risk of recurrence. Ramirez and colleagues originally described the components separation technique in 1990. This technique accomplishes primary fascial closure over the midline through bilateral the external oblique aponeurotomis lateral to the linea semilunaris. Several techniques including the perforator-sparing technique, minimally invasive laparoscopic approaches, and posterior component separation have been developed to improve the outcomes. Managements, such as the use of synthetic and bioloprosthetic mesh, for reinforcement adjunctively have further decreased the rate of complications. Further refinements and prospective studies will be needed to achieve more durable repairs.

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Use of Acellular Dermal Matrix in Reconstructive Surgery: A Review
Ji Won Park, Soo Wook Chae, Byung Min Yun
Journal of Medicine and Life Science.2021; 18(3): 56. CrossRef

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Emergency surgery

Umbilical Varix Herniating Through Umbilical Defect and Mimicking Incarcerated Hernia: Grigoriy V. Klimovich, Minjeong Kwon, Jenna L. Klimovich, Edward B. Lineen; J Acute Care Surg 2016;6(2):71-72. Published online October 30, 2016; DOI: https://doi.org/10.17479/jacs.2016.6.2.71

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The patient is a 43-year-old male with medical history significant for severe alcoholic cirrhosis who presented with a one-month history of periumbilical pain. The patient did not have any symptoms of bowel obstruction. Physical examination revealed an umbilical defect containing an intra-abdominal structure, mimicking incarcerated umbilical hernia. Computed tomography revealed an engorged, umbilical varix 1.6 cm in diameter, herniating through the umbilical defect. No surgical intervention was offered for this patient and medical management for varix resulted in clinical resolution in three months.