International Surgery Journal | January-March 2016 | Vol 3 | Issue 1 Page 357 International Surgery Journal Vagholkar K et al. Int Surg J. 2016 Feb;3(1):357-360 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Single staged surgical procedure for recurrent incisional hernia with trophic ulceration: a viable surgical option Ketan Vagholkar*, Madhavan Iyengar, Suvarna Vagholkar INTRODUCTION The incidence of incisional hernia despite improvement in surgical techniques continues to be in the range of 10 to 15%. 1 Even in urban cities the condition may go undiagnosed eventually leading to a multitude of complications. Trophic ulceration leading to rupture of an incisional hernia is quite an uncommon condition requiring a judicious management algorithm in order to prevent a recurrence or further complications. We report here a case of trophic ulceration in a long standing recurrent incisional hernia with loss of domain in order to highlight the pathophysiology and surgical options for managing such a case. CASE REPORT A 48 year old female presented with a recurrent incisional hernia through a lower midline scar. The patient had undergone hysterectomy 10 years back following which she developed an incisional hernia. She had neglected the hernia swelling as a result of which it increased in size over a period of time. She then underwent surgical repair of the incisional hernia at a district hospital. 3 years after the repair the hernia recurred. She did not seek any surgical treatment. The hernia increased in size eventually leading to irreducibility. However she did not give any history of obstructive symptoms. The overlying skin as per her history developed hyper pigmentation, thinning and eventually broke down. She also gave history of discharge from the ulcerated area. She sought treatment from a general practitioner who referred her to our facility. She did not have any medical comorbidity. General examination revealed normal vital parameters. Local examination revealed a large incisional hernia with significant loss of domain. There was an ulcer 2 inches in diameter on the most dependent part of the hernia swelling (Figure 1). The margins were ill defined with scant pale granulation tissue in the floor of the ulcer. The base of the ulcer was formed by loop of intestine confirmed by gurgling sensation while palpating the base ABSTRACT Incisional hernia by itself is a very challenging surgical disease to treat. Recurrent incisional hernia with trophic ulceration adds to the complexity of the problem making surgical treatment more difficult. A case of a recurrent incisional hernia with trophic ulceration treated by a single staged procedure comprising of wide excision of the trophic ulcer with repair of the incisional hernia is presented to highlight the applicability of a single staged procedure as a viable option for managing such complex hernias. Keywords: Incisional hernia, Trophic ulceration Department of Surgery, D. Y. Patil University School of Medicine, Navi Mumbai, India Received: 16 December 2015 Accepted: 02 January 2016 *Correspondence: Dr. Ketan Vagholkar, E-mail: kvagholkar@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20160075