Strangulated crural hernia with intestinal resection under local anaesthesia and repair with prosthetic material : a limit case?

The use of prosthetic materials in the treatment of strangulated hernias in association with intestinal resection certainly represents a limit case. A potentially contaminated operating field is no doubt contraindicated to the placement of a prosthesis, but with an accurate preparation of the space, a perfect haemostasis, an optimal antibiotic treatment, it may then become feasible. A 90-year-old woman was referred to us with a painful strangulated crural hernia, abdominal distension, vomiting and occlusion. Under local anaesthesia, the sac was isolated, opened and a necrotic intestinal loop resected; then an end-to-end ileum-ileal anastomosis was performed and the hernial defect repaired with a prosthesis. Although in literature there are no case reports on the subject, the association intestinal resection-prosthesis use is not inhibited. Our experience in the specific case provides additional evidence supporting our belief that potentially infected but optimally prepared operating fields are well suited to the prosthetic repair of hernial defects.