Acute postoperative strangulated ventral hernia after a Video Assisted Lobectomy

Alexander Ramirez, MD, FACS¹, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS². ¹Tallahassee Memorial Hospital / Florida State University, ²Cleveland Clinic Florida

This is a case of a 56 year old female admitted for surgical treatment of right lower lobe pulmonary nodule (Fig. 1).

Her surgical history is remarkable for a vertical banded gastroplasty 33 years ago for obesity and multiple abdominal surgeries for small bowel obstruction and hernia repair. She underwent 13 years ago a conversion to Roux-en-Y gastric bypass at Cleveland Clinic Florida and two more hernias repairs with mesh.

In March 2015 she underwent Right VATS (Video Assisted Thoracic Surgery), Right Upper Lobe Wedge Resection, Right Lower Lobe Wedge Resection, Right Lower Lobectomy and Right Mediastinal Lymph Node Dissection. In POD 2 the patient got an episode of Acute Mental Status changes and abdominal pain with incarcerated ventral hernia. An abdominal CT scan shows a high grade small bowel obstruction with incarcerated hernia (Fig 2)

The patient was taken to the operating room after resuscitation (Fig. 3).

We founded multiple abdominal wall hernia defects, multiple adhesions, and strangulated cecum (Fig. 4).

We removed from the midline a chronic infected mesh (Fig.5).

We performed an Exploratory Laparotomy, extensive Lysis of Adhesions, reduction of strangulated incisional hernia, Right hemicolectomy with end ileostomy by colorectal team, removal of old mesh and closure of abdominal wall with acellular porcine dermal graft (Fig. 6).