title: Strangulated epigastric hernia in a 90-year-old man: Point-of-Care Ultrasound (POCUS) as a saving kit: Case report.
abstract: BACKGROUND
  The physiological reserve of extreme elderly patients is very limited and has major impact on clinical decisions on their management. Hereby we report a 90-year-old man who presented with a strangulated epigastric hernia and who developed postoperative intra-abdominal bleeding, and highlight the value of Point-of-Care Ultrasound (POCUS) in critical decisions made during the management of this patient.
  
  
  METHODS
  A 90-year-old man presented with a tender irreducible epigastric mass. Surgeon-performed POCUS using colour Doppler showed small bowel in the hernia with no flow in the mesentery. Resection anastomosis of an ischaemic small bowel and suture repair of the hernia was performed. Twenty four hours after surgery, in a routine follow up using POCUS, significant intra-peritoneal fluid was detected although the patient was haemodynamically stable. The fluid was tapped under bedside ultrasound guidance and it was frank blood. During induction of anaesthesia for a laparotomy, the patient became hypotensive. Resuscitation under inferior vena cava sonographic measurement, followed by successful damage control surgery with packing, was performed. 36h later, the packs were removed, no active bleeding could be seen and the abdomen was closed without tension. The patient was discharged home 50 days after surgery with good general condition.
  
  
  CONCLUSIONS
  POCUS has a central role in the management of critically-ill elderly patients for making quick critical decisions.
authors.affiliation: Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates. Electronic address: fabuzidan@uaeu.ac.ae.
authors.forename: Fikri M
authors.initials: FM
authors.lastname: Abu-Zidan
authors.affiliation: Intensive Care Unit, Al-Ain Hospital, Al-Ain, United Arab Emirates. Electronic address: kidrees@seha.ae.
authors.forename: Kamal
authors.initials: K
authors.lastname: Idris
authors.affiliation: Surgical Institute, Al-Ain Hospital, Al-Ain, United Arab Emirates. Electronic address: melhassan@seha.ae.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khalifa
keywords: Critical care; Elderly; Epigastric hernia; Point-of-care; Strangulated; Ultrasound