Treatment with negative pressure and biological mesh reconstruction of full-thickness abdominal wall necrosis due to a strangulated incisional hernia: A Case report

Abstract Incisional hernia (IH) is not rare and is prone to a number of different complications. We present herein a case of a huge IH originating from a Pfannenstiel incision, complicated by bowel strangulation with gangrene and perforation and subsequent abdominal wall necrosis. The clinical presentation was delayed until a frank peritonism developed due to intestinal gangrene, accompanied by a large, full-thickness necrosis of the abdominal wall. The patient presented septic shock and was managed by extensive debridement, peritoneal toilet and drainage, intestinal resection, and ileostomy. The open abdomen treatment was established and subsequent intra-abdominal negative pressure therapy. After the resolution of sepsis and granulating tissue formation, stoma closure and implant of a biological mesh completed the treatment, achieving full healing of the abdominal wall. The open abdomen, coupled with intra-abdominal negative pressure therapy, is a well-established method for the management of abdominal wall defects due to congenital disorders, abdominal wall tumors, necrotizing infections, previous abdominal surgeries, trauma, and trauma-associated infections. Complications in large IH in obese patients may have a misleading clinical presentation causing delays in treatment and resulting in challenging situations. However, accurate treatment like that employed in this case warrants good results reducing hospital stays and costs.