Incisional hernias are a common complication of laparotomies and present a challenging surgical problem. The potentially fatal complication of spontaneous rupture and evisceration is rare and requires urgent surgical repair. Intraoperative decision making requires careful assessment of all patient factors and experience with advanced hernia repair techniques. Oftentimes, these hernias are giant sized and there is associated atrophy and ulceration of the overlying skin with a stretched and weakened anterior abdominal wall. Spontaneous rupture and evisceration has been most commonly described in patients with end-stage liver disease and ascites which makes surgery hazardous in this subset of patients. Surgical technique must minimize the occurrence of complications as well as hernia recurrences in these challenging hernias and the surgeon must decide on the use of mesh, the type of mesh, its position and also the use of additional techniques such as component separation. We present a case of the spontaneous rupture of a giant incisional hernia with evisceration of small intestine that was successfully repaired using polypropylene mesh and component separation.
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