45 Year Old Female presentinng with Pain and Hardness in the Lower Abdomen 1.5 years follwoing surgery

A 45 year-old, housewife, with the history of hysterectomy 1.5 years back is complaining of generalized weakness, abdominal pain and feeling of hardness like potato below the umbilicus from last January at the site of previous surgery and was gradually worsening in intensity but improves following disappearance of the hardness. She also added that her pain aggravates during coughing. Before surgery (hysterectomy) she used to have frequent urinations and was not able to hold urine and during urination she was feeling that something is swollen and was painful. She was told to have distended urinary bladder which had to be treated by reducing its size during the hysterectomy operation. Although presently she doesn’t feel of a distended bladder but does feel the same pain.  After surgery she was not able to urinate which was managed by putting urinary catheter. She also added that few days after surgery she has had fever and infection at surgical site which was managed with some antibiotics. 

She also has a history of surgery for gall stones and appendicitis 22 years back. She has no history of diabetes mellitus and hypertension. Her parents didn’t have a history of any hernia.

She experiences pain in her both knees from past few years (didn’t remember the duration) and indigestion for which she used to take some acid reducing agents and insomnia for which she takes some sleeping pills (rivotril). Otherwise she doesn’t take any other medicines. She doesn’t chew tobacco or drink alcohol.

Her USG Lower abdomen was done which is suggestive of an incisional hernia (fig 1, 2, 3). 

Figure 1

 

Figure 2

Figure 3