Sigmoid Diverticulitis in a Tight Spot: An Atypical Presentation Within a Ventral Hernia

Ventral hernia and acute diverticulitis may present with similar symptoms posing difficulty in clinical diagnosis. Rarely, complicated sigmoid diverticulitis is found within an irreducible ventral hernia sac in the emergency setting. Intraoperative decision on the appropriate surgical option depends on the surgeon's experience and the patient's clinical state. We present a case of a middle-aged female who came in with infraumbilical hernia containing necrotic sigmoid diverticulitis. Her surgical history was cesarean section and total abdominal hysterectomy with a re-look laparotomy. She had an emergency exploration of the hernia through a midline incision, excision of the necrotic diverticulum, and the formation of loop colostomy at the site of the hernia. Post-operative recovery was uneventful and she has been scheduled for an elective sigmoid colectomy and reversal of the stoma. This study highlights that complicated sigmoid diverticulitis can rarely present as an irreducible ventral hernia and that less is often more in safely getting patients out of trouble in an emergency.