This friendly lady presented to me 2 years ago for a painful swelling which resolved after a day of admission. She then went missing and reappeared with the same complaint a few days ago. I was in Kuching then and she refused to go home. She insisted on seeing me and after seeing me she insisted on going back only after surgery was done no matter how long it was going to take. She knew that if she were to go home she would end up defaulting treatment as she was a single mother and financially strained.

She has 9 children and this swelling has been there ever since (more than 10 years), growing bigger and bigger till present size.

The swelling was so big that it caused her to have difficulty in taking care of herself. The underside of the swelling developed fungal infection due to the moist and ulcerated.

The operation :
the neck of the hernia

the sac opened and the sneak view of its contents

almost two thirds of the small bowel was within the mass(hernia)

The sac and the excess skin excised revealing the abdominal wall defect: she is lucky because if the bowels twisted within its axis, the blood supply would be obliterated and she would end up dead with two thirds of her small bowel ischaemic.

The defect was closed and repaired with a mesh. She is well and presently at home.

** see the comments for why she delayed her treatment.