Abdominal Hematoma After IPOM Repair of an Incisional Hernia Mimicking a Recurrence: A Case Report on the Role of Diagnostic Laparoscopy

AIM: Incisional hernia (IH) and especially postoperative recurrences of IH persist as a common and extremely costly problem to treat and manage. In case of suspected recurrence, radiological studies are frequently misleading and/or inconclusive. With our case report, we aim to define the diagnostic and therapeutic role of a diagnostic laparoscopic approach. CASE PRESENTATION: We report a case of a pseudo-recurrence of a ventral IH in a patient who had undergone IH Intraperitoneal Onlay Mesh (IPOM) repair. Recurrent IH was suspected due to the occurrence of an abdominal bulge and the findings of the abdominal wall Computed Tomography (CT) scan. CT showed an abdominal wall mass over the fascia containing a fluid-air level at the site of the mesh, highly suggestive of recurrent IH with bowel loop entrapment. At diagnostic laparoscopy, the prosthesis was shown to be well-positioned and no recurrent IH was detected. Conversely, a subcutaneous encapsulated hematoma was identified at the abdominal incision over the bulge. RESULTS: The patient experienced a fast and smooth postoperative recovery and was discharged symptom-free in good general conditions. CONCLUSIONS: In cases of suspected recurrent IH and in the presence of inconclusive imaging studies, diagnostic laparoscopy can play an important role, ensuring a minimally invasive approach and avoiding overtreatment.