Early preoperative progressive pneumoperitoneum for a symptomatic giant abdominal incisional hernia

INTRODUCTION AND IMPORTANCE: Early preoperative progressive pneumoperitoneum (PPP) is a technique that helps large eventrations with loss of domain to reintroduce protruded organs. However, a standardized technique has not been developed. This technique has been proved in elective patients, but the evidence is scarce in patients with a high risk of incarceration/strangulation. CLINICAL FINDINGS AND INVESTIGATIONS: We present a 61-year-old patient with history of a thoracoabdominal aneurysm repair, developed a massive incisional hernia with loss of domain. At admission, he presented with abdominal pain and inability to reduce the hernia by himself, however it reduced after clinical examination. Aortic syndromes were excluded. INTERVENTIONS AND OUTCOME: After a multidisciplinary meeting, early PPP was initially performed. Later he was taken to surgery and admitted in the ICU to prevent abdominal hypertension. Medical complications resolved within 14 days. The patient did not report long-term complications. RELEVANCE AND IMPACT: PPP is a technique that pursues the prevention of abdominal hypertension syndrome in patients with large hernias with loss of domain electively. For patients with high risk of hernia complications, the evidence is limited regarding the applicability of early PPP. A multidisciplinary team can improve decision making and therefore reduce the risk of long-term complications. We show a case where PPP was performed in an acute painful, reducible hernia with a high risk of incarceration, showing that this approach can be an option for acutely ill patients.