Background: Incisional hernias are common complications following abdominal surgery, with known risk factors including age, obesity, and suture types. Giant incisional hernias, especially with loss of abdominal domain, present significant challenges for surgical repair, particularly in emergency settings. Case Presentation: A 50-year-old Pakistani female was presented with mild cognitive dysfunction and a history of multiple cesarean sections, presented with a giant pedunculated incisional hernia associated with severe skin necrosis. The patient’s condition deteriorated rapidly, necessitating urgent surgical intervention. Intraoperatively, a large hernia defect was identified, and despite the complexities posed by skin necrosis and the need for omental resection, successful reduction, and repair were achieved using mesh overlay. Postoperatively, the patient showed satisfactory recovery without respiratory compromise, highlighting the importance of tailored approaches in managing complex incisional hernias, even in challenging clinical scenarios.
Conclusion: The repair of a giant incisional hernia with loss of domain is extremely challenging especially when presenting in emergency settings. Repair without component separation was difficult; however, it was carried out and tolerated by the patient without complications. This reflects the variability in surgical management in patients presenting with giant incisional hernia and emphasizes the importance of taking all patient-related factors and the settings at presentation into consideration.
Key words: Incisional hernia, abdominal wall hernia, mesh repair, case report
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