VENTRAL WALL HERNIATION AFTER CESAREN DELIVERY COMPLICATES FUTURE PREGNANCIES

Purpose: The purpose of this case report is to present a patient that had a pregnancy with a portion of the uterus in the hernia sac and potential compromise to the fetus. She also developed significant cellulitis and fistulous tracts around her hernia. Hernias large enough to encompass all or a portion of the growing uterus are a rare complication of some pregnancies. Our patient had several complicating issues arise due to her large, ventral wall hernia. Methods: Involved a retrospective chart review of the management of a patient with a ruptured ovarian ectopic pregnancy. A literature review was undertaken for management points. Results: A 24 year old, gravida 3, para 2 was seen for her prenatal care and delivery of her baby. She had had a previous wound infection with her last cesarean that left a large ventral wall hernia on her abdomen. She quickly became pregnant again and the subsequent pregnancy was complicated by a portion of the growing fetus and uterus extending into the hernia sac. She received increased fetal surveillance during her pregnancy. Maternal-fetal medicine consulted throughout her pregnancy. She was also admitted for intravenous antibiotics for cellulitis and fistulous tracts developing from old pocket of infection possibly form her previous abscess pockets. The patient ultimately underwent repeat cesarean and intraoperative hernia repair with mesh placement. Post-operatively she did well. Conclusions: Ventral wall hernias will be seen more commonly as the rate of cesarean rises in the United States. Providers will need to be familiar with a variety of significant complications that may arise in these high-risk pregnancies. The patient outcome will likely be improved with a multispecialty approach to their pregnancy management.