Multiple ventral hernias in a 30-year-old female with Down syndrome: a case report and review of the literature.

backgroundVentral hernias are common abdominal wall defects, usually occurring as isolated entities related to prior surgery, trauma, or increased intra-abdominal pressure. The occurrence of multiple synchronous ventral hernias in a single patient is rare, and reports in individuals with Down syndrome are particularly scarce. Down syndrome is associated with connective tissue abnormalities, hypotonia, and ligamentous laxity, which may predispose patients to hernia formation. However, multiple simultaneous ventral hernias in this population have not been widely described. This case adds to the limited literature by presenting an unusual constellation of three synchronous ventral hernias in an adult female with Down syndrome, highlighting the diagnostic and therapeutic challenges in such patients. CASE PRESENTATION: A 30-year-old Baluch female with Down syndrome presented with a 2-month history of abdominal pain, progressive swelling, postprandial vomiting, anorexia, constipation, and weight loss. She had no history of prior abdominal surgery. Clinical examination revealed epigastric tenderness and protrusions along the linea alba. Abdominal ultrasonography confirmed two distinct fascial defects containing omentum, consistent with ventral hernias. Preoperative evaluation was significant for hypothyroidism and long QT syndrome but otherwise unremarkable. Following optimization, she underwent open surgical repair via a midline incision. Intraoperative exploration revealed three discrete fascial defects, ranging from 0.5 to 2 cm in diameter, each with hernia sacs. The sacs were excised, the defects connected, and closure was performed with non-absorbable sutures reinforced by an onlay polypropylene mesh. The postoperative course was uneventful. She resumed oral intake on the first postoperative day, was discharged on the second day, and showed no evidence of recurrence or complications at 30-day follow-up. At 1 month, she had returned to normal daily activities with satisfactory wound healing.

conclusionsThis case adds to the limited literature on multiple ventral/epigastric hernias in individuals with Down syndrome. It highlights the need to consider multiple fascial defects when evaluating abdominal wall symptoms in patients with communication limitations, the complementary value of physical examination, ultrasonography, and intraoperative assessment, and the importance of tailoring the surgical approach to patient-specific factors and local resource availability.