Strangulated cholecystitis in an umbilical hernia: world-first case report

Background: Strangulated umbilical hernia and acute cholecystitis are among the most common surgical emergencies, with operative management remaining the cornerstone of treatment. This study describes, to our knowledge, the first documented case worldwide of acute cholecystitis strangulated within an umbilical hernia. Case presentation: A 97-year-old woman with a history of recurrent choledocholithiasis presented to the Acute Care Department with abdominal pain localized to the mesogastrium and an irreducible, tender periumbilical mass. Abdominal computed tomography scan described a strangulated intestinal loop, prompting urgent surgical intervention. Surprisingly, exploratory laparotomy revealed an acute cholecystitis strangulated within the umbilical hernia, along with marked dilation of the common bile duct measuring up to 2 cm. Thus, a cholecystectomy and common bile duct exploration were performed, revealing a 2 cm non-obstructive gallstone at the ampulla of Vater, which was successfully extracted. A T-tube was then placed for biliary drainage, and the abdominal wall was closed primarily. The patient was discharged on postoperative day 14 in fair overall clinical condition and the subsequent follow-up was regular. Conclusion: This case underscores the importance of maintaining a high index of suspicion for atypical hernia contents and highlights the need for individualized surgical decision-making. Gallbladder herniation, though rare, can lead to diagnostic challenges. Successful management requires both technical expertise and sound clinical judgment in urgent settings.