Ultrasound-guided Hernia Reduction-Preventing Surgery for an Incarcerated Ventral Hernia: A Case Report

Hernias are a common presenting complaint in the emergency department. If they are not promptly identified and reduced, patients may need urgent surgery, which entails an increase in morbidity and mortality. The diagnosis and reduction of hernias can be challenging due to a patient's large body habitus. In this case, we demonstrate the utility of using point-of-care ultrasound (POCUS) to detect an abdominal wall defect and provide real-time guidance to reduce a hernia and avoid surgery in a patient who was a poor surgical candidate.

A 48-year-old morbidly obese male with multiple comorbidities presented with abdominal pain at the location of a known ventral hernia. Computed tomography (CT) of the abdomen confirmed a ventral hernia; however, three different physicians attempted reduction and were unsuccessful. We then used POCUS to identify the ventral hernia and the abdominal wall defect and to guide the subsequent reduction efforts. Guidance of the reduction started with locating the abdominal wall defect, which allowed for gentle, steady pressure to be applied at the site of the defect and visualization of the successful reduction in real time. This led to immediate improvement in the patient's symptoms.

The success of this reduction highlights how POCUS can be used to improve the success rate for manual ventral hernia reduction without the need for confirmatory CT. It can also help to avoid increased morbidity and mortality from unplanned, unoptimized surgical hernia repair in high-risk patients.