International Journal of TROPICAL DISEASE & Health

Background: Epigastric hernia is a common occurrence in surgical practice globally; however, it is often “sacless”. This study reports the clinical features, reviews the literature, and discusses the rare finding of a giant epigastric hernia containing the caecum and other viscera.

Methods: Consent was obtained from the patient and the hospital’s Research and Ethics Committee. The clinical case notes of the patient, who first presented in February 2026 and re-presented in September 2026, were used to extract data for the study.

Case Presentation: A 37-year-old female patient (Gravida 5, Para 2, with 2 alive) presented with an 8-year history of abdominal protrusion associated with occasional pain. The swelling gradually increased from a small mass to approximately the size of the patient’s two palms, without associated obstructive symptoms. Significant examination findings included a young woman with morbid obesity (BMI = 48.7 kg/m²), with a pendulous protruding epigastric mass measuring 20 cm by 25 cm. Laboratory investigations were normal. A diagnosis of a huge pendulous impacted epigastric hernia was made in a multiparous woman with morbid obesity. She underwent elective hernia repair and abdominoplasty under general anaesthesia. Intra-operatively, a huge epigastric hernia sac containing the caecum, ascending colon, appendix, terminal ileum, and greater omentum was found. She underwent appendicectomy, Mayo’s repair, and abdominoplasty, with a satisfactory outcome.

Conclusion: A rare combination of three features—an epigastric hernia with a sac, giant size, and a wandering caecum—is reported in a young woman with morbid obesity.