case_images: PMC11705993_01
case_images: Showing the anterior (a) and lateral (b) views of the preoperative state of the woman.
case_images: rjae834f1.jpg
case_images: PMC11705993_01_rjae834f1.jpg
case_images: f1
case_images: Physical examination revealed a morbidly obese woman (Body Mass Index = 50 kg/m2) with a reducible giant paraumbilical hernia with loss of abdominal domain (Fig. 1a and b).
case_images: Showing (a) the incision unveiling the content covered with the sac; (b) the hernia sac; (c) the appendix (Blue arrow), PAM and colon (arrow head) continuing with the transverse colon; and (d) excessive fat on the mesentery.
case_images: rjae834f2.jpg
case_images: PMC11705993_01_rjae834f2.jpg
case_images: f2
case_images: An extended lower midline abdominal incision approach was adopted (Fig. 2a). The hernia sac was carefully dissected (Fig. 2b). The content of the hernia sac included a viable appendix, caecum, ascending colon, and part of the transverse colon which were separated, inspected and reduced (Fig. 2c and d). Furthermore, it was found that the ascending colon was directly continuous with the transverse colon with no physical boundary as shown in Fig. 2c.
case_images: Showing the onlay 30 x 30 cm polypropylene mesh in-situ.
case_images: rjae834f3.jpg
case_images: PMC11705993_01_rjae834f3.jpg
case_images: f3
case_images: An onlay mesh repair was fashioned where a 30 x 30 cm polypropylene mesh was placed on the reconstructed abdominal wall (Fig. 3) and secured with nylon 3-0 sutures and the skin was closed with nylon 2-0.