case_images: PMC10831638_01
case_images: Preoperative tomography showing incisional hernia.
case_images: jaws-02-11767-g001.jpg
case_images: PMC10831638_01_jaws-02-11767-g001.jpg
case_images: F1
case_images: After 2 years, she developed a 12 cm (length) x 10 cm (width), involving zones M2, M3, and M4 according to the EHS (European Hernia Society) classification, incisional hernia in the previous midline incision, observed on abdominal CT scan (Figure 1).
case_images: Transposition hernia Sac surgery technique - (A) - Opening of the hernia sac (B) - Anterior incision in the right rectal sheath and posterior incision in the left rectal sheath. (C) - Suturing the hernia sac flap to the right with the lateral portion of the left posterior rectal sheath and suturing the medial portion of the left rectal sheath to the medial suture of the right medial rectal sheath. (D) - Suturing the hernia sac flap to the left with the lateral portion of the right anterior rectal sheath.
case_images: jaws-02-11767-g002.jpg
case_images: PMC10831638_01_jaws-02-11767-g002.jpg
case_images: F2
case_images: We opted for abdominal wall reconstruction by transposition of the hernia sac without mesh placement (Figures 2, 3) due to the high risk of abdominal wall complication as necrosis, bleeding and infection associated with recent bevacizumab use and hepatopathy.
case_images: Final appearance of the surgery.
case_images: jaws-02-11767-g003.jpg
case_images: PMC10831638_01_jaws-02-11767-g003.jpg
case_images: F3
case_images: We opted for abdominal wall reconstruction by transposition of the hernia sac without mesh placement (Figures 2, 3) due to the high risk of abdominal wall complication as necrosis, bleeding and infection associated with recent bevacizumab use and hepatopathy.
case_images: Abdominal tomography on the sixth postoperative day showing an intact abdominal wall with a small amount of supra-aponeurotic fluid.
case_images: jaws-02-11767-g004.jpg
case_images: PMC10831638_01_jaws-02-11767-g004.jpg
case_images: F4
case_images: CT scan performed on the 6th postoperative day due to constipation and increased abdominal volume revealed mild inflammatory fluid and intestinal distension without signs of bleeding or obstructive factors (Figure 4). Clinical management of constipation and measures to address hepatic decompensation were instituted with a positive response.