The patient is a 43-year-old male with medical history significant for severe alcoholic cirrhosis who presented with a one-month history of periumbilical pain. The patient did not have any symptoms of bowel obstruction. Physical examination revealed an umbilical defect containing an intra-abdominal structure, mimicking incarcerated umbilical hernia. Computed tomography revealed an engorged, umbilical varix 1.6 cm in diameter, herniating through the umbilical defect. No surgical intervention was offered for this patient and medical management for varix resulted in clinical resolution in three months.
Adult ; Hernia* ; Hernia, Umbilical ; Humans ; Hypertension, Portal ; Liver Cirrhosis, Alcoholic ; Male ; Physical Examination ; Varicose Veins*

A 51-year-old female underwent recurrent open incisional hernia repair with retrorectus mesh placement. Early in the post-operative course, she developed a hernia reoccurrence secondary to breakdown of the staple line, at the level of the posterior rectus sheath, resulting in a small bowel obstruction. This hernia could not be felt upon physical examination but was detected by imaging. The patient was promptly taken to the operating room for laparoscopic reduction of the incarcerated loop of small intestine, along with laparoscopic repair of the posterior rectus sheath defect. It is critical for surgeons to recognize the possibility of a staple line breakdown at the level of posterior rectus sheath early on in the diagnosis which would prompt urgent surgical intervention in the setting of a bowel obstruction.

A 51-year-old female underwent recurrent open incisional hernia repair with retrorectus mesh placement. Early in the post-operative course, she developed a hernia reoccurrence secondary to breakdown of the staple line, at the level of the posterior rectus sheath, resulting in a small bowel obstruction. This hernia could not be felt upon physical examination but was detected by imaging. The patient was promptly taken to the operating room for laparoscopic reduction of the incarcerated loop of small intestine, along with laparoscopic repair of the posterior rectus sheath defect. It is critical for surgeons to recognize the possibility of a staple line breakdown at the level of posterior rectus sheath early on in the diagnosis which would prompt urgent surgical intervention in the setting of a bowel obstruction.