Avoidable death from complicated epigastric hernia in a resource limited setting

Abstract

An epigastric hernia is a defect in the ventral abdominal wall, that is often diagnosed under routine exam, and requires surgical management which if not undertaken may lead to strangulation. We present the case of a 20-year-old female of poor social setting, with no relevant past history who was brought to the emergency room with severe abdominal pains, fever and vomiting, of five days for which she had been taking traditional herbal medications. Upon physical examination she was clinically febrile, pale and septic, with signs of dehydration and hemodynamic instability. There was a necrotic supra-umbilical offensive ulcer and crepitus on almost the entire surface of the anterior abdominal wall. A working diagnosis of necrotizing fasciitis was made and she was planned for immediate surgery. Intraoperative findings were necrotizing fasciitis and necrosed loop of bowel in the anterior abdominal wall suggestive of strangulated hernia which worsened into necrotizing facitis. The postoperative period was marked by septic shock and death. Strangulated epigastric hernia remain a surgical emergency as it can be deadly if complicated. Care should be taken about the use of traditional medicine and proper counseling should be made to patients.