A 53 year old man undergoes a reversal of a loop colostomy. He recovers well and is discharged home. He is readmitted 10 days later with symptoms of vomiting and colicky abdominal pain. On examination he has a swelling of the loop colostomy site and it is tender. What is the most likely underlying diagnosis? A. Haematoma B. Intra abdominal adhesions C. Anastomotic leak D. Anastomotic stricture E. Obstructed incisional hernia Theme from September 2011 Exam In this scenario the most likely diagnosis would be obstructed incisional hernia. The tender swelling coupled with symptoms of obstruction point to this diagnosis. Prompt surgical exploration is warranted. Loop colostomy reversals are at high risk of this complication as the operative site is at increased risk of the development of post operative wound infections. Acute incisional hernia Any surgical procedure involving entry into a cavity containing viscera may be complicated by post operative hernia The abdomen is the commonest site The deep layer of the wound has usually broken down, allowing internal viscera to protrude through Management is dictated by the patients clinical status and the timing of the hernia in relation to recent surgery Bowel obstruction or tenderness at the hernia site both mandate early surgical intervention to reduce the risk of bowel necrosis Mature incisional hernias with a wide neck and no symptoms may be either left or listed for elective repair Risk factors for the development of post operative incisional hernias include post operative wound infections, long term steroid use, obesity and chronic cough Theme: Abdominal stomas A. End ileostomy B. End colostomy C. Loop ileostomy D. Loop colostomy