A 65 year old lady presented with an painful swelling over the umblicus which was progressively worsening. This was associated with more frequent episodes of vomiting and the inability to open her bowel and pass wind. Her abdomen was progressively inceaasing in size and this percipitated her already failing heart and poorly controlled diabetes causing her to be breathless and even more swollen. She was also morbidly obese. She was definitely not one of the best of patients but surgery is definitely indicated - earlier the better for her with such poor background history. The diagnosis : Intestinal Obstructon from incarcerated / strangulated paraumbilical hernia.
It looks small but remember she is big.
This is the hernial sac which had an a short segment of the transverse colon stuck within the sac together with some omentum.
Sorry about picture quality - did not realise my batteries were dying.
The end result,
She got better and have started eating on day 2 after surgery. Yesterday night 4 days after surgery, I visited her to wish her Selamat Hari Raya before the long break and cought her munching away on some butter bun secretly while lying on her tummy as not to be seen by the nurses — no wonder her blood sugars does not seem to be coming down. And obviously her heart failure has subsided making her feel much better. Then again, some habits are hard to die and some lessons in life are too painful to learn.