Left hepatic lobe herniation through an incisional anterior abdominal wall hernia

A 65 year old female with bronchial asthma on a regular visit to Chest Medicine department at M.S. Ramaiah Memorial hospital, Bengaluru, India, complained of pain in the right hypochondrium in June 2011. She was obese and had huge diffuse swelling in the epigastric region. She had undergone open cholecystectomy about 10 years back. There was no history of trauma. Computed tomography (CT) abdomen revealed herniation of left lobe of the liver through the epigastric region predominantly on right side (Figure). Obesity and the previous abdominal surgery may have contributed to the incisional hernia formation. Herniation of the liver through an anterior abdominal wall surgical incision is rare. Liver as part of omphalocele content has been described in the neonatal period1. Only a few cases of hepatic hernia have been described in the literature2. Treatment involves abdominal wall reconstruction and the decision is made on an individual basis. Our patient had no symptoms related to hepatic hernia at two and a half years from the time of diagnosis. She is on regular follow up for bronchial asthma and coronary artery disease.

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Fig.

CT abdomen showing herniation of left lobe of the liver (arrow) through the epigastric region predominantly on the right side.

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