Giant incisional hernia with a protruding pregnant uterus and overlying thinned-out ulcerated skin: A case report and review of literature

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.