It is the final episode of our Challenging Cases in Emergency General Surgery series and we’re diving into another dreaded topic: the complex abdominal wall. This structure is a daily partner to the general surgeon—but when things go wrong, it can quickly become our biggest challenge. In this episode, we’ll walk through the emergency presentation of a patient with multiple prior hernia repairs and mesh placements, and how these complicate diagnosis and management. From imaging pearls to OR decision-making and post-op dilemmas, this episode covers it all.  We round things off with a fun game (as always!) and some hot takes on abdominal wall strategies in emergency general surgery. Whether you’re an EGS surgeon, trainee, or surgical enthusiast, this episode is packed with practical insights, decision-making frameworks, and real-world nuance.

Hosts:

- Dr. Ashlie Nadler

- Dr. Jordan Nantais

- Dr. Graham Skelhorne-Gross

Learning Objectives:

- Identify key factors to assess in patients presenting with complex abdominal wall problems, including detailed surgical history, hernia characteristics, and signs of complications.

- Discuss the role of imaging, particularly CT scans, in evaluating patients with ventral hernias and bowel obstruction, with a focus on identifying transition points and signs of strangulation.

- Outline the surgical approach to incarcerated incisional ventral hernias, including pre-operative considerations, operative techniques, and management of threatened bowel.

- Recognize the importance of patient-specific factors and interdisciplinary collaboration in the management of complex abdominal wall cases, including the role of pre-habilitation and hernia specialists.

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