Case report of an enormous ventral hernia containing a kidney.

Introduction and importance: Incisional ventral hernias, a form of acquired hernia, are a common complication of abdominal surgery, with a documented incidence of up to 20 %. Retroperitoneal organs tend to be less associated with ventral hernias, and, to our knowledge, there is only one other report of an incisional hernia containing a kidney. In this case report, we document an extremely rare incidence of a male who developed a giant incisional hernia post-exploratory laparotomy and was found to have his right kidney present within the hernia sac. Case presentation: A 49-year-old male with a history of a large, complex ventral hernia with involvement of the right kidney. At the time of initial presentation, his BMI was considered prohibitive for a durable repair. He subsequently lost 275 pounds through combined surgical and lifestyle efforts. The CT scan demonstrated a massive ventral hernia containing nearly the entire colon and all small bowel, measuring 9.7cm × 10.1 cm, and the right kidney demonstrated interval clockwise rotation. The patient underwent an open hernia repair with retrorectus mesh placement. Postoperatively, the patient recovered well. Clinical discussion: In this case, CT imaging identified not only extensive herniation of abdominal contents but also an unusual clockwise rotation and partial obstruction of the right kidney. While intraperitoneal contents have been described in large ventral hernias, retroperitoneal organ involvement is exceedingly rare. Conclusion: This case adds to the evolving understanding of hernia behavior in post-bariatric and underscores the need for heightened intraoperative awareness when encountering large, chronic defects.