Case studies · Hernia · Emergency surgery · De-identified
Case study: strangulated umbilical hernia — emergency surgery the same night, bowel saved
A woman in her late sixties had lived with an umbilical hernia for about fifteen years. One night it stopped going back in, and within hours she had severe abdominal pain and vomiting. She came to the Sharvari Hospital emergency department that night with a strangulated hernia — a loop of small bowel trapped in the hernia opening with its blood supply cut off — and was taken for an emergency laparotomy the same night. This page shows what was found, why the operation could not wait for morning, why the bowel recovered without a resection in her case, and why no mesh was placed.
This page contains an explicit operating-theatre photograph and a short muted video of open abdominal surgery. Both are blurred until you choose to view them.
Presentation
A woman in her late sixties was brought to the Sharvari Hospital emergency department at night by her family. She had had a soft swelling at the navel for about fifteen years. It had never troubled her much: it came out when she stood or coughed, went back in when she lay down, and she had been told at some point that it could be repaired whenever she chose. She had not chosen to.
That evening the swelling came out and, for the first time, did not go back in. It became hard and tender to touch. Over the following hours she developed cramping pain across the abdomen, then vomiting, and by the time the family brought her in she was in constant, severe pain and had not passed wind for several hours.
On examination the swelling at the navel was tense, tender and could not be reduced — pressed gently, it did not go back in, and attempting more would have been unsafe. The abdomen was distended and the bowel sounds were altered. Her pulse was fast. Blood tests and an X-ray were done at the bedside while the anaesthetist assessed her. The clinical picture was a strangulated umbilical hernia with early bowel obstruction.
What “strangulated” means
A hernia is a gap in the abdominal wall through which the contents of the abdomen — usually a loop of bowel or a piece of the fatty apron (omentum) — push outward under the skin. For years this can be harmless: the contents slide out and back through the gap freely, which is why a long-standing hernia is often described as “reducible”.
A hernia becomes incarcerated when the contents get stuck in the gap and cannot be pushed back. It becomes strangulated when the gap is tight enough to squeeze the blood vessels running to the trapped loop. Blood can no longer get in or out. Deprived of its blood supply, the trapped segment of bowel swells, darkens and, over a matter of hours, begins to lose viability. The bowel upstream, blocked at the trapped point, distends — which is what causes the cramping pain, the vomiting and the inability to pass wind or stool.
This is why the timing matters, and it is a matter of plain physiology rather than alarm. Bowel that has lost its blood supply for a short time can recover completely once the pressure is released; bowel that has been without blood supply for longer cannot, and that segment has to be removed and the two healthy ends joined. The difference between the two is decided largely by how quickly the loop is released — which is decided by how quickly the patient reaches a hospital that can operate.
The decision: why this could not wait for morning
A strangulated hernia is a surgical emergency. There is no medicine that restores the blood supply to a trapped loop of bowel, and no benefit in waiting to “see how it settles”: every hour the loop stays trapped, the chance that it can be saved falls and the chance of a bowel resection, with its longer and more complicated recovery, rises. The indication was clear on examination, and the decision was to operate that night.
That decision is only possible if the hospital can act on it. Sharvari Hospital has an in-house operating theatre, an anaesthesia team and nursing cover available 24×7, so a patient who arrives with a strangulated hernia at night is not stabilised and transferred, and does not wait for a morning list. The pre-anaesthetic assessment, consent from the patient and her family, intravenous fluids and antibiotics, and a nasogastric tube to decompress the stomach were completed while the theatre was prepared, and she was taken up for surgery the same night.
An open operation (laparotomy) was chosen rather than a laparoscopic one. When bowel is strangulated and distended, an open approach lets the surgeon release the loop directly, inspect its full length in good light, and — if a segment is no longer viable — remove it and rejoin the bowel safely. Laparoscopy is the standard for planned hernia repair; for a strangulated hernia with obstruction, the priority is the bowel, and an open approach is the more dependable way to deal with it.
In the operating theatre
Under general anaesthesia the abdomen was opened through an incision around the navel. A loop of small bowel was found trapped in the hernia opening, tightly gripped at the neck. Above the constriction the bowel was distended; the trapped loop itself was dark, dusky and swollen — the appearance of bowel whose blood supply has been cut off.
The hernia neck was widened with a small cut so that the loop could be released without tearing it. The freed loop was then wrapped in warm, moist packs and watched. This is the decisive moment in every strangulated hernia: the surgeon waits to see whether the bowel recovers or whether it must be removed.
In this patient’s case, because the loop had been reached in time, its colour returned over a few minutes — the dusky purple faded to pink, the bowel wall regained its sheen, and pulsation was felt in the small vessels feeding it. The labelled photograph shows the released loop as its colour and blood supply recovered on the table. No part of the bowel had to be removed. The loop was returned to the abdomen and the rest of the small bowel was inspected along its length and found healthy.
The short muted video was recorded in theatre after the loop had been released. It shows the freed segment of small bowel being handled and inspected, with its colour recovering, before it was returned to the abdomen. It is shown here because a photograph cannot convey what “the bowel recovered” actually looks like — the change is something the surgeon watches for, not something decided in advance.
The video is explicit open surgery. It does not autoplay, and it is blurred until you choose to view it.
Why no mesh was placed
In a planned hernia repair, a lightweight mesh is placed behind the muscle wall to reinforce the gap, because mesh reinforcement substantially lowers the chance of the hernia coming back compared with stitches alone. In this operation the hernia was closed with sutures only, and the mesh was deliberately left out.
The reason is contamination. Strangulated bowel leaks fluid and bacteria into the operative field even when it recovers, and the operation is done as an emergency on an unprepared patient. A mesh is a foreign body: placed into a contaminated field it is at real risk of becoming infected, and an infected mesh usually has to be removed in a further operation. In an emergency of this kind the safer decision is to close the defect with strong sutures, let the wound heal cleanly, and consider a planned mesh reinforcement later if the repair stretches or a recurrence appears. That later operation, if it is ever needed, would be done as a clean, planned procedure — usually laparoscopically.
A suture-only closure is therefore not a lesser repair in this setting. It is the appropriate one, and the trade-off — a somewhat higher chance of recurrence in exchange for a much lower chance of a mesh infection — is explained to every patient afterwards.
Recovery
In this patient’s case, recovery was straightforward. She was monitored in the hospital overnight, was sipping fluids the next morning once the bowel had started moving, progressed to a light diet, and was walking with support on the first day. She was discharged home after a three-day stay with wound-care instructions and a follow-up date. At review the wound had healed and she was back to her normal routine. That is her course, not a promise: recovery after an emergency laparotomy depends on the patient’s age, general health and above all on whether a bowel resection was needed, and it is planned for each patient individually.
Recovery after an emergency operation of this kind is slower than after a planned laparoscopic repair — a larger wound, a hospital stay of a few days rather than same-day discharge, and several weeks before heavy lifting. Where a segment of bowel has had to be removed, the stay and the recovery are longer again. All of this is the cost of the delay, not of the hernia itself.
Warning signs of a hernia emergency
A hernia that has been soft and reducible for years can strangulate without warning. If you have a hernia — of any kind, of any age — these five signs mean it needs to be examined in an emergency department now, not at the next available appointment:
- 1
Sudden, severe pain at the hernia or across the abdomen. A hernia that has never hurt, or has only ached, and suddenly becomes very painful has changed.
- 2
A swelling that will not go back in. A bulge that used to disappear when you lay down, and now stays out and feels hard, is incarcerated. Do not keep pushing it.
- 3
Nausea or vomiting. Vomiting with a hernia that will not reduce means the bowel is likely blocked at the trapped point.
- 4
Redness, warmth or marked tenderness over the swelling. Skin changes over the bulge suggest the trapped contents are inflamed or losing their blood supply.
- 5
Not passing wind or stool, with a swollen abdomen. This is the picture of bowel obstruction and confirms that the hernia needs urgent surgical attention.
With any of these, go to an emergency department that has a surgical team and an operating theatre available around the clock — do not wait for morning, and do not eat or drink on the way, because an operation is likely. Sharvari Hospital’s emergency department is open 24×7: +91 951 951 1928.
A hernia you have “had for years”
The most common reason a hernia is not repaired is that it does not hurt. This patient’s hernia had been reducible and comfortable for fifteen years, and nothing about those fifteen years predicted the night it strangulated. A hernia is a physical gap in the abdominal wall; it does not close on its own, and a gap that has been harmless for a long time is not, for that reason, safer — an umbilical hernia with a small, firm neck is if anything more likely to trap what passes through it.
Repaired on your own terms, the same hernia is a very different operation. A planned laparoscopic hernia repair is usually a short day-care or overnight procedure: three small keyhole incisions, a mesh placed behind the muscle wall under clean conditions, discharge the same or next day for most patients, and a return to desk work within a few days. Compare that with an open emergency laparotomy at night, a suture-only repair, a three-day stay and the very real possibility of a bowel resection — and the case for having a known hernia examined and repaired before it forces the issue makes itself.
If you have a hernia and are not sure whether it needs repair, an examination settles it. Some small, symptom-free hernias can reasonably be observed under a surgeon’s guidance; the point is that the decision should be made by examination, not by waiting to see whether it becomes a problem.
What this case shows
A fifteen-year-old, comfortable umbilical hernia strangulated in a single evening. Because the patient was brought in the same night, and because the hospital could take her to theatre the same night, the trapped loop of bowel was released while it could still recover — and in her case it did, with no resection, a suture repair and a three-day stay. The two decisions that shaped that outcome were made before the operation: the family’s decision not to wait until morning, and the hospital’s ability to operate when she arrived. Neither can be counted on if a strangulated hernia is treated as something that can wait.
Watch the 40-second clip on our YouTube channel — the released loop recovering its colour, as described above.
Consent and privacy
This case is published for patient education with the patient’s written consent. No name, patient identifier, date of admission, report or hospital number is shown; age is given only as a range and no time-to-theatre figure is stated. The operating-theatre photograph and video are cropped to the operative field so that no identifying feature is visible, and both are blurred until a visitor chooses to view them; the video does not autoplay. Social-media previews of this page use only a blurred image. Every case study on this site follows the same rule: the anatomy and the decision are shared, the person is not.
A hernia that is suddenly painful or will not go back in? Come now
Sharvari Hospital’s emergency department, operating theatre and anaesthesia team are available 24×7. If you or a family member has a hernia with sudden severe pain, a swelling that will not reduce, vomiting, redness over the bulge or a swollen abdomen with no wind or stool passing, call +91 951 951 1928 and come in — day or night.
Have a hernia that is not an emergency? Planned laparoscopic repair — types, technique, recovery and cost — is set out at hernia surgery in Pune.
Your surgeon: Dr. Kundan Kharde, MS, FMAS — Founder & Director, Laparoscopic & General Surgeon, Sharvari Hospital. 19+ years, 6,000+ surgeries.
SR. NO. 19(P), behind Gulmohor Park, Vishal Nagar, Pimple Nilakh, Pune 411027 · Open 24 hours · +91 951 951 1928