Voluminous paraumbilical hernia containing the pancreas – An unusual cause of acute pancreatitis: A case report. (September 2019)

• Record Type: Journal Article
• Authors: Komaei, Iman; La Malfa, Giuseppe; Damiano, Cristina; Sarra, Federica; Cassaro, Gabriele; Barbera, Adalberto; Bartolotta, Marcello; Currò, Giuseppe; Navarra, Giuseppe
• Is Part Of: Annals of medicine and surgery. Volume 45(2019)
• Page Start: 6
• Page End: 10
• Publication Date: 2019-09
• Subjects: Paraumbilical hernia -- Intestinal obstruction -- Emergency laparotomy -- Acute pancreatitis -- Case report; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2019.07.017
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: The paraumbilical hernia sac often contains the omentum, the small bowel, and less commonly the colon. The herniation of the pancreas through a paraumbilical hernia is extremely rare and has been reported only by two cases in the literature; moreover, acute pancreatitis secondary to this condition is a particularly unusual event. Case report: We present a very unusual case of a 67-year-old female patient with a voluminous paraumbilical hernia containing the pancreas, complicated by acute pancreatitis. Laboratory data revealed an elevation of the pancreatic enzymes. An intravenous contrast-enhanced computed tomography (CT) scan of the abdomen demonstrated a large hernia sac containing multiple viscera, including the pancreas. The patient underwent emergency laparotomy with a diagnosis of intestinal obstruction. Conclusion: The clinicians should consider this rare condition in the differential diagnosis of patients presenting with large paraumbilical hernias associated with classical symptoms of acute pancreatitis, particularly in the absence of typical risk factors for pancreatitis. An intravenous contrast-enhanced abdominal CT scan should be performed immediately in these patients. We recommend the patients and the surgeons to consider prompt surgical repair for paraumbilical hernias to avoid further complications and the higher incidence of morbidity and mortality associated with emergency surgeries. Highlights: Paraumbilical hernia sac often contains omentum, small bowel, and seldom colon. Herniation of pancreas through a paraumbilical hernia is an extremely rare event. Pancreatitis linked to paraumbilical hernias is associated with high mortality. Prompt surgical repair of umbilical hernias in high risk patients is recommended.