Make an imaginory case of a umbilical hernia with typical history including pc hopi past history family history and examination part

Reading File

Finding Sources

Reading File

Finding Sources

Now I have enough textbook content. Let me compose a thorough, realistic imaginary clinical case for umbilical hernia.

Imaginary Clinical Case: Umbilical Hernia (Adult Para-umbilical Hernia)

PATIENT DETAILS

Name: Mrs. Savita Devi Age: 48 years Sex: Female Occupation: Housewife Address: Village Rampur, District Kanpur, Uttar Pradesh Religion: Hindu Marital Status: Married Date of Admission: 11 July 2026 Ward: General Surgery, Male / Female Ward Registration No.: 2026/SGW/1142

CHIEF COMPLAINT (PC)

Swelling near the navel for 3 years
Pain at the site of swelling for 6 months

HISTORY OF PRESENTING ILLNESS (HOPI)

Mrs. Savita Devi, a 48-year-old obese housewife, presented to the surgical OPD with a gradually progressive swelling near the umbilicus for the past 3 years. The swelling was first noticed as a small, soft bulge just above the umbilicus after her fourth delivery. It was initially the size of a marble and was completely reducible on lying down. She noticed that the swelling increased in size on straining, coughing, or during physical exertion, and disappeared spontaneously when she lay flat - classic intermittent nature.

Over the past 6 months, she has been experiencing a dull aching pain at the site of the swelling, aggravated by prolonged standing and physical activity, and partially relieved on lying down. The swelling has gradually enlarged and is no longer completely reducible. There is no history of vomiting, bowel obstruction, change in bowel habits, or fever.

She denies any redness, skin ulceration, or sudden increase in pain suggestive of strangulation.

Pertinent Negatives:

No vomiting or abdominal distension
No constipation or absolute constipation
No fever or chills
No urinary complaints
No skin breakdown over the swelling

PAST HISTORY

Obstetric history: G4P4L4 - four full-term normal vaginal deliveries; the youngest child is 4 years old. The hernia was first noticed after the last delivery.
Medical history: Known case of hypothyroidism on levothyroxine 50 mcg once daily for 5 years. No history of diabetes mellitus, hypertension, or tuberculosis.
Surgical history: Underwent appendicectomy 18 years ago (lower midline incision). No previous abdominal wall surgeries.
Drug history: Levothyroxine 50 mcg OD. No known drug allergies (NKDA).
Menstrual history: Regular cycles, 28-day cycle, 4-5 days of flow. No menorrhagia or dysmenorrhea. Not yet menopausal.

FAMILY HISTORY

No similar swelling reported in any first-degree relatives.
Mother has type 2 diabetes mellitus.
Father had inguinal hernia (operated 20 years ago).
No family history of colorectal cancer, connective tissue disorders, or abdominal malignancies.

PERSONAL HISTORY

Diet: Mixed (vegetarian and non-vegetarian)
Appetite: Normal
Bowel habits: Regular, once daily
Micturition: Normal
Sleep: Adequate
No history of smoking, alcohol, or tobacco use
BMI: 31.4 kg/m² (obese class I)

GENERAL PHYSICAL EXAMINATION

General appearance: Middle-aged, obese woman, conscious, cooperative, and oriented to time, place, and person. No acute distress at rest.

Parameter	Finding
Built	Obese
Nutrition	Well-nourished
Pallor	Absent
Icterus	Absent
Cyanosis	Absent
Clubbing	Absent
Lymphadenopathy	Absent
Oedema	Absent
Pulse	82 bpm, regular, good volume, all peripheral pulses palpable
Blood Pressure	126/82 mmHg, right arm, sitting position
Temperature	98.6°F (afebrile)
Respiratory rate	18 breaths/min
SpO2	98% on room air
Weight	74 kg
Height	153 cm
BMI	31.6 kg/m²

LOCAL EXAMINATION (Abdomen)

Inspection

Shape of abdomen: Obese, pendulous, with increased subcutaneous fat
Umbilicus: The umbilicus is displaced and distorted by a globular swelling just above and to the right of it. The skin over the swelling is normal; no redness, no ulceration, no thinning or skin changes. Umbilicus appears to be everted and "crescent-shaped" due to the hernia bulge (classic finding per Bailey & Love's, p. 1094)
Swelling: Approximately 5 × 4 cm, soft, non-tender at rest, located in the para-umbilical region (just superior to the umbilicus)
Visible peristalsis: Absent
Abdominal wall veins: Not prominent
Scars: Old appendicectomy scar in the right iliac fossa

Palpation

Temperature: Not raised over the swelling
Tenderness: Mild tenderness on deep palpation
Consistency: Soft and doughy - suggestive of omentum in the sac; no firm resonant feel (which would suggest bowel)
Reducibility: Partially reducible - reduces about 60% on lying down with gentle pressure; firm fibrous edge of the fascial defect in the linea alba is clearly palpable after partial reduction
Neck/ring: Narrow neck palpable - approximately 2 cm in diameter; fascial edge is firm and fibrotic
Cough impulse: Positive - swelling increases in size and becomes more tense on coughing (tested with patient standing)
Hernial orifice (after reduction): Palpable fascial defect in the linea alba, above the umbilicus, approximately 2 cm in diameter with firm, non-expansile edges

Percussion

Over the swelling: Dull note - consistent with omental contents (fatty, non-resonant)
Rest of abdomen: Tympanitic in central regions, dull in flanks (no free fluid)

Auscultation

Over swelling: No bowel sounds heard within the sac (confirms omental content)
Abdomen: Normal bowel sounds present; no bruits

SYSTEMIC EXAMINATION

Respiratory system: Air entry bilaterally equal; no added sounds; no respiratory compromise
Cardiovascular system: S1, S2 heard; no murmurs; no signs of heart failure
Central nervous system: Cranial nerves intact; no focal neurological deficit
Per abdomen (overall): Liver and spleen not palpable; no free fluid; no organomegaly

PROVISIONAL DIAGNOSIS

Acquired para-umbilical hernia - partially irreducible, containing omentum, with mild chronic pain. No signs of obstruction or strangulation at present.

DIFFERENTIAL DIAGNOSIS

Para-umbilical hernia (most likely)
Acquired umbilical hernia proper
Epigastric hernia (less likely given site and size)
Lipoma of the umbilical region
Umbilical abscess or infected sebaceous cyst

INVESTIGATIONS PLANNED

Complete blood count (CBC), RBS, serum electrolytes, kidney function test
Coagulation profile (PT/INR)
USG abdomen - to assess hernia contents, rule out intra-abdominal pathology, screen for ascites
Chest X-ray PA view
ECG (pre-operative)
Thyroid function test (TFT) - given known hypothyroidism
Blood grouping and cross-matching

MANAGEMENT PLAN

Conservative:

Dietary advice (weight reduction)
Avoid heavy lifting and straining
Optimize hypothyroidism before surgery

Surgical:

Elective open hernioplasty with mesh repair (Mayo repair with mesh overlay) under spinal or general anaesthesia
As per Bailey & Love's and current evidence, mesh repair is preferred even for defects >2 cm due to high recurrence rates with primary suture repair alone

Sources: S Das Manual on Clinical Surgery 13th Ed., p. 5808-5822; Bailey and Love's Short Practice of Surgery 28th Ed., p. 1094-1096; Schwartz's Principles of Surgery 11th Ed., p. 535

This case covers all the standard components expected in a surgical long case: chief complaint, detailed HOPI, past history (obstetric, medical, surgical), family history, personal history, general physical examination with vitals, and a complete local examination (inspection, palpation, percussion, auscultation) followed by provisional and differential diagnoses and a management plan. The clinical features are all grounded in textbook descriptions of acquired para-umbilical hernia in an obese multiparous woman, which is the classic presentation.

This is a shared conversation. Sign in to Orris to start your own chat.