Incarcerated Ventral Hernia Requiring Emergent Repair in an Adult With Down Syndrome: Diagnostic and Postoperative Challenges in an Underrepresented Population

TL;DR

This case report discusses the challenges of diagnosing and managing an incarcerated ventral hernia in an adult with Down syndrome, emphasizing the need for personalized care.

Contribution

The paper presents a unique case highlighting diagnostic and postoperative challenges in adults with Down syndrome, an underrepresented population in surgical studies.

Findings

The patient experienced multiple postoperative complications, including obstipation and pulmonary emboli.

Limited clinical history necessitated reliance on physical examination and imaging for diagnosis and management.

Personalized monitoring and multidisciplinary approaches are crucial for complex cases in adults with Down syndrome.

Abstract

The manifestation of ventral hernias is quite common, with an increased risk of progressing to incarceration/strangulation, which imposes the need for emergent surgery. Patients with Down syndrome (DS) present unique anatomical, physiological, and neurodevelopmental characteristics that may complicate diagnosis and postoperative management. In general, DS has been well studied for perioperative risk primarily with pediatric and cardiac populations, yet emergency general surgical outcomes in adults remain poorly studied. In our case report, a 59-year-old woman with DS and Alzheimer’s disease underwent emergent robotic ventral hernia repair for an incarcerated ventral hernia. Her postoperative course was complicated by several features, including obstipation, urinary retention with bilateral hydronephrosis, and the development of bilateral segmental and subsegmental pulmonary emboli on postoperative day four. Interventions for these complications, such as a Foley catheter insertion for urinary retention, led to additional complications. Diagnosis and management were primarily guided by physical examination and cross-sectional imaging, given the patient’s limited ability to provide a reliable clinical history. Our case report highlights the challenges of standard postoperative care in adults with DS and also stresses the importance of personalized monitoring, diagnostic imaging, and multidisciplinary approaches, especially for individuals with complex disease processes.

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