Objective:

To report a rare case of gastric outlet obstruction caused by a paraumbilical hernia in a young male with class III obesity and to review relevant literature.

Approach:

• Case Description: A 38-year-old man with class III obesity presented with daily post-prandial vomiting, weight loss, and chronic constipation due to a giant irreducible paraumbilical hernia containing the stomach.
• Imaging and Diagnosis: Contrast-enhanced CT revealed a fascial defect containing small bowel, transverse colon, omentum, and stomach, with extrinsic gastric outlet obstruction.
• Surgical Intervention: An open Rives–Stoppa retrorectus mesh repair was performed, and the patient had an uneventful recovery.
• Literature Review: A focused narrative review of literature on stomach-containing ventral hernias and gastric outlet obstruction was conducted.

Key Findings:

• Gastric outlet obstruction from a stomach-containing paraumbilical hernia is exceptionally rare, particularly in young patients.
• Chronic intra-abdominal pressure and hernia contents can lead to gastric migration into the hernia sac.
• Successful surgical repair can resolve symptoms and restore normal function.

Interpretation:

The case illustrates that paraumbilical hernias can lead to significant complications like gastric outlet obstruction even in younger patients with severe obesity.

Limitations:

• The case study is based on a single patient, which limits the generalizability of the findings.
• The literature review is narrative and not exhaustive, which may affect the comprehensiveness of the insights.

Conclusion:

This case highlights the importance of considering gastric outlet obstruction in young patients with significant obesity and paraumbilical hernias.

Sources:

• CARE 2013 Reporting Guidelines