Undiagnosed simultaneous umbilical and femoral hernias complicated by ascites: a case study of a 13-year-old girl at the Iringa Regional Referral Hospital in Iringa, Tanzania

Abstract

Concurrent umbilical and femoral hernias are unusual instances defined by an intra-abdominal bulge caused by abnormalities in the abdominal wall at the umbilical ring and the femoral canal in the upper thigh/groin area. Untreated femoral hernias provide a danger of strangulation, imprisonment, and intestinal blockage. This disorder is more frequent in females and affects youngsters more than adults. Concurrent umbilical and femoral hernias accompanied by ascites are extremely rare and can be corrected surgically. A 13-year-old girl from Mawelewele, Iringa, was presented with abdominal swelling and back discomfort. She had a history of chronic abdominal TB with recurrent ascites for four years. The patient had roughly one liter of yellowish discharge with a bad odor, which was accompanied by increased abdominal distention but no vomiting or diarrhea. She reported acute back discomfort with no aggravating or alleviating causes. The discomfort was linked with lower limb pain, fatigue, and limited mobility. There was no history of trauma. The patient had a four-year history of recurring abdominal distension, for which she had visited Benjamin Mkapa Hospital several times. And was diagnosed with abdominal TB, requiring numerous ascitic taps. And was receiving ant tuberculosis medication, albeit the regimen and adherence were not properly documented. She lost weight gradually, had low-grade fever on and off, and coughed intermittently throughout her illness. There was no prior history of bowel abnormalities, urinary complaints, hematemesis, or melena. The findings of an abdominal ultrasound indicated that a patient had significant ascites at Morrison's pouch, and an MRI revealed that a patient had huge ascites secondary? Correlate clinically. The patient had no hepatitis B or C, and the chest X-ray showed normal results. The decision was made to operate on the patients and remove their fluids while repairing the umbilical and femoral hernias. Under general anesthesia in the supine position, the patient was aseptically cleansed and draped before the incision was performed. Loculated ascitic fluid, a loop of viable small bowel in the hernia sac. Approximately 3000 ml of loculated ascitic fluid were extracted. Reduction of viable small bowel, excision of superfluous sac, and sublay mesh hernioplasty were performed, and the patient was alleviated of his previous complaints and symptoms. He was discharged after five days with a four-week follow-up. The patient totally healed and returned to school, which she had missed for nine months. Umbilical and femoral hernias complicated by ascites in the setting of chronic abdominal tuberculosis should be managed surgically, which was successfully done with sublay mesh hernioplasty, and the girl was rescued after four years of suffering due to misdiagnosis of the simultaneously umbilical and femoral hernia complicated by ascites as abdominal tuberculosis. Following that, the nutritional status improved.