Life-Saving Emergency Surgery for a Critical Abdominal Wall Hernia at Bombay Gastro & Cancer Institute, Bathinda
A 45-year-old female with a history of recurrent incisional hernia presented to the emergency department with severe abdominal pain, persistent vomiting, fever, abdominal swelling, and septic shock. Clinical examination revealed a tense, irreducible, and extremely tender hernia, raising strong suspicion of strangulation with bowel gangrene.
Following urgent clinical assessment and resuscitation, the patient was diagnosed with a strangulated recurrent incisional hernia, one of the most serious complications of abdominal wall hernias requiring immediate emergency surgery.
Emergency Surgical Management
The patient was immediately taken to the operating theatre, where Dr. Raman Garg, Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda, performed an emergency exploratory laparotomy.
During surgery, the hernia sac was found to contain gangrenous small bowel, confirming prolonged strangulation with complete loss of blood supply. In addition, the overlying skin and subcutaneous tissue had also become gangrenous due to severe pressure and compromised circulation.
To control the infection and save the patient's life, the following procedures were performed:
- Resection of the gangrenous small bowel.
- End ileostomy.
- Hartmann's procedure.
- Excision of all gangrenous skin and subcutaneous tissue.
- Thorough abdominal washout and control of intra-abdominal sepsis.
All non-viable tissue was completely removed, and effective source control was achieved.
Postoperative Recovery
Despite presenting in septic shock, the patient recovered remarkably well.
- Gradual resolution of sepsis.
- Well-functioning ileostomy.
- Gradual resumption of oral intake.
- No major postoperative complications.
- Discharged in satisfactory condition on the 7th postoperative day.
Why This Case Is Important
A strangulated recurrent incisional hernia is one of the most dangerous abdominal wall emergencies. Delayed treatment can rapidly lead to bowel gangrene, perforation, overwhelming sepsis, multi-organ failure, and death.
This case was particularly challenging because, in addition to gangrenous bowel, the overlying abdominal wall skin and subcutaneous tissues had also become gangrenous, requiring simultaneous bowel resection and extensive soft tissue excision.
This successful outcome highlights the importance of early diagnosis, rapid resuscitation, timely emergency surgery, aggressive control of infection, and meticulous postoperative care. It also reflects Dr. Raman Garg's expertise in managing complex abdominal wall hernias, bowel gangrene, perforation peritonitis, emergency gastrointestinal surgery, and abdominal wall reconstruction.
Advanced Hernia and Emergency Gastrointestinal Surgery by Dr. Raman Garg
Dr. Raman Garg is a leading Surgical Gastroenterologist in Bathinda, with extensive experience in the treatment of inguinal hernia, incisional hernia, ventral hernia, recurrent hernia, strangulated hernia, abdominal wall reconstruction, intestinal obstruction, bowel gangrene, perforation peritonitis, colorectal diseases, gallbladder disorders, liver and pancreatic diseases, gastrointestinal cancers, and advanced laparoscopic surgery.
Patients from Bathinda, Punjab, Haryana, Rajasthan, and neighbouring states seek his expertise for both elective and emergency gastrointestinal surgery, complex hernia repair, hepatopancreatobiliary (HPB) surgery, colorectal surgery, and minimally invasive surgical procedures.
Patient: 45-year-old Female
Diagnosis: Recurrent Strangulated Incisional Hernia with Gangrenous Small Bowel, Gangrene of Overlying Skin and Subcutaneous Tissue, and Septic Shock
Procedures Performed: Emergency Exploratory Laparotomy, Resection of Gangrenous Small Bowel, End Ileostomy, Hartmann's Procedure, and Excision of Gangrenous Skin and Subcutaneous Tissue
Operating Surgeon: Dr. Raman Garg, Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon, Bombay Gastro & Cancer Institute, Bathinda
Outcome: Successful emergency surgery with resolution of sepsis, uneventful postoperative recovery, and discharge on the 7th postoperative day.
About Dr. Raman Garg
Dr. Raman Garg is a Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic and HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda. He specializes in gastrointestinal cancer surgery, liver, pancreas and bile duct surgery, colorectal surgery, hernia surgery, upper GI surgery, emergency abdominal surgery, and advanced minimally invasive procedures.
Patient identity has been withheld to maintain confidentiality. This case is shared for educational purposes with appropriate consent and privacy safeguards.
