The Complexity of Managing a Burned Irreducible Umbilical Hernia in an Adult

We present a case of a 65-year-old male with a longstanding non-symptomatic irreducible umbilical hernia who presented with a three-day-old full-thickness thermal burn to the hernia. The burn was sustained while operating a metal drop forger, where the patient was repeatedly exposed to 30-second bursts of heat from the furnace, with temperature exceeding 1350°C. He estimated he had this exposure approximately 48 times during an 8-hour shift, giving him a total of 24 minutes cumulative exposure to the heat. The patient reported that he normally wore an abdominal binder under his heat-resistant apron to temporarily flatten and protect his hernia. On the day of the injury, he had not been wearing this binder. The patient was initially unaware that he had sustained a burn; upon delayed presentation to the hospital, he had cellulitis surrounding a 0.25% total body surface area (TBSA) full-thickness burn. Contrast-enhanced CT abdomen demonstrated an umbilical hernia with a neck diameter of 2.3cm, with breach of the hernia fascia but no communication between the bowel and burnt tissue. After discussion between Plastic Surgery and General Surgery teams the decision was made to manage the burn non-operatively with daily flamazine dressings and empirical antibiotics for the cellulitis. Once this area had healed, elective mesh repair of the umbilical hernia was carried out. This is the first adult case of a full-thickness burn overlying an umbilical hernia to be reported in the literature. The case highlights both an unusual aetiology and a rare injury, as well as the multi-disciplinary teamwork required to manage it successfully.