80 year old hypertensive was admitted for poorly controlled HPT. A large paraumbilical swelling was found and referred to surgery team. Mass was described as a 20×30cm soft fluctuant mass , irreducible and initially non tender. Patient had lived with this mass for the past 12 months. The rest of the abdomen was unremarkable. A decision was taken to work her up for surgery. Mass became tender within 72 hrs prompting an emergency laparotomy.
Examination : Tender, fluctuant, irreducible
Diagnosis : Strangulated Paraumbilical hernia
Surgery : Laparotomy
Findings: hernia sac containing almost the whole of the stomach with a 5cmperforation on the greater curvature of stomach . Biopsy from edges of perforation taken and closure done with omental patch.
Postoperative : Patient was not making adequate urine post surgery. Pateint expired on 4th day post op from acute kidney injury .