DOI: 10.14260/jemds/2015/538 CASE REPORT J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 4/ Issue 21/ Mar 12, 2015 Page 3736 DUAL MIDLINE VENTRAL HERNIA: A UNIQUE CASE Sangamesh B. Tondare 1 , Md. Shafiuddin 2 , Shradha 3 , Mahesh B. Tondare 4 , D. Srinivasan 5 HOW TO CITE THIS ARTICLE: Sangamesh B. Tondare, Md. Shafiuddin, Shradha, Mahesh B. Tondare, D. Srinivasan. “Dual Midline Ventral Hernia: A Unique Case”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 21, March 12; Page: 3736-3740, DOI: 10.14260/jemds/2015/538 ABSTRACT: Dual midline ventral hernia although not very common, a combination of infraumbilical with incisional hernia is unique. A obese lady in her sixth decade of life was diagnosed as having this unique combination and was treated by meshplasty and removal of umbilicus. Postoperative period was uneventful and patient discharged on 7th postoperative day. KEYWORDS: Incisional Hernia, Umblical Hernia, Meshplasty. INTRODUCTION: Incisional hernias develop in 3.8–11.5% of cases after abdominal surgery. The incidence depends on a number of factors including old age, sex, obesity, bowel surgery, suture type, chest infection, abdominal distension and wound infection. (1,2) Ninety percent of incisional hernias occur within 3 years of operation. (3) Repair of large abdominal incisional hernias is a difficult surgical problem with recurrence being a common complication. Recurrence rates of up to 33% after first repair and 58% after second repair have been reported. (4) Umbilical hernias are common in obese individuals. CASE DESCRIPTION: A 63 years old lady was referred by Gynaecologist to Surgery department with diagnosis of incisional hernia. On taking a detailed history it was found that she had pain in both flanks and lower abdomen since 6 years, increased since 1 month. Past history revealed that she was operated for tubectomy 30 years back. Four years after the surgery she developed a swelling at the operated site, which was progressively increasing in size for which she got operated 12 years back. After the surgery over a period 12 years, she has again developed a swelling over the abdomen which is progressively increasing in size to attain the present size. She is a known case of hypertension since 15 years. She has 4 children. General physical examination revealed vitals in normal range. Per abdomen examination revealed she had infraumblical hernia since 6 years, with incisional hernia Fig. 1. Skin over the incisional hernia was very much thinned out showing early features of impending rupture. On investigation by Ultrasonography the diagnosis was confirmed but revealed that incisional hernia has 2 sacs 1 measuring 3 *2 cms and another 2.5*2.4 cms. Patient was told about the treatment options at our hospital after which she was worked up for other investigations and taken for surgery. Patient was also told about removal of umbilicus and mesh repair. During surgery a slightly curved midline incision extending from above umbilicus to site of incisional hernia was taken. Two sac were noted at incisional hernia site one in midline 7 cms below umbilicus and another 2 cms lateral to midline below the former sac Fig. 2. The contents of sac were found to be omentum at both the sites with adhesions to sac. After reducing the contents, umbilicus was excised and the primary repair was done, followed by mesh repair Fig. 3. Suction drain was placed in the subcutaneous fat. Skin was then approximated with deep sutures Fig. 4. The patient is being followed since one year after the wound healing Fig. 5.