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Incarcerated hernia around a suprapubic catheter

Incarcerated incisional hernia through a suprapubic urinary catheter (SPC) trocar site is an extremely rare surgical emergency. We report a 73-year-old lady who presented with a 1-day history of colicky abdominal pain and distension associated with bilious vomiting and constipation. A permanent SPC had been inserted 5 years earlier for bladder prolapse and urge incontinence. Examination revealed a distended abdomen as well as a markedly tender and irreducible lump immediately adjacent to her SPC. Abdominal computer tomography scan confirmed a small bowel obstruction secondary to incarcerated terminal ileum and caecum, which herniated through a 3-cm anterior abdominal wall defect alongside the SPC (Fig. 1). Prompt exploration through a Pfannenstiel incision made just above the hernia demonstrated no evidence of intestinal ischaemia. The intestines were returned back into the abdominal cavity following gentle manipulation, and the hernial orifice closed with interrupted prolene stitches. We decided against mesh repair because of the potential risk of mesh infection from the adjacent contaminated SPC. No hernia recurrence was detected at follow-up. Intestinal herniation around a SPC is rare, with this case being the sixth reported in the English literature. Suprapubic catheterization is usually entirely extraperitoneal; however, if the trocar breaches the peritoneum before entering the distended bladder, and with the bladder subsequently decompressed by the SPC, repeated abdominal straining may encourage intestinal herniation through the peritoneal weakness introduced by the trocar. All hernias around an SPC require surgical repair as the neck is narrow and prone to obstruction. Whether mesh is incorporated into the repair has advantages and disadvantages. Mesh repair may offer a lower incidence of hernia recurrence when compared with sutured repair, but may be counterbalanced by a higher risk of mesh infection because of close proximity to a contaminated SPC. To protect against mesh infection, one report advocates for the removal of the (a) (b)