[Perforated, fistulized-to-skin ileum within a large incarcerated umbilical hernia].

A 76-year-old female patient presented to our hospital because of skin necrosis with purulent exudate from a four to five-standing relapsed umbilical hernia with no associated fever, vomiting, or bowel obstruction signs. Her relevant history included diabetes mellitus and high blood pressure, as well as hernioplasty for an umbilical hernia that relapsed twice. Examination reveals a large tender, irreducible relapsed umbilical hernia apparently including multiple sacs. Laboratory testing revealed increased urea and creatinin levels, as well as leukocytosis and neutrophilia. The lesion is explored in the outpatient minor surgery room, and reveals no subcutaneous abscess but a supurating hernial sac; hence we ordered an emergency abdominal CT scan (Fig. 1) for suspected perforation of hernial contents (multisaccular umbilical hernia with the lower sac showing thickened intestinal loops, and a fistula and abscess in its lower portion, all of this consistent with intestinal perforation, with no bowel obstruction signs in the remaining intetsine). In view of these findings a surgical procedure is performed, where a post-laparotomy multisaccular hernia with perforated distal ileum is uncovered; a resection with ileal latero-lateral anastomosis is carried out, followed by herniorrhaphy and musculoaponeurotic border suture using Quenu’s technique (the pathology report described it as ulcerated ischemic ileitis with Letters to the Editor 1130-0108/2007/99/11/672-680 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2007 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 99, N.° 11, pp. 672-680, 2007