{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:46:30Z","timestamp":1782283590327,"version":"3.54.5"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastric outlet obstruction (GOO) caused by a paraumbilical hernia is exceptionally rare. The stomach is normally tethered by its peritoneal attachments and seldom migrates into a midline ventral defect; reported cases have almost exclusively involved elderly patients, in whom acquired ligamentous laxity has been invoked as a permissive factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case description<\/jats:title>\n                    <jats:p>\n                      A 38-year-old man with lifelong class III obesity (peak BMI 48.2\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), severe obstructive sleep apnoea and a sliding hiatal hernia presented with a one-year history of daily post-prandial non-bilious vomiting, learned self-induced emesis to relieve hernia distension, profound unintentional weight loss (from 126.4 to 89\u2005kg, a 30% reduction) and chronic constipation. Examination revealed a giant irreducible paraumbilical hernia. Contrast-enhanced computed tomography (CT) demonstrated a fascial defect measuring 5.6\u2009\u00d7\u20097.5\u2005cm (transverse\u2009\u00d7\u2009cranio-caudal) containing small bowel, transverse colon, omentum and stomach, with a transition point at the distal antrum and pylorus indicating extrinsic GOO and no evidence of malignancy. Endoscopy showed two-level extrinsic compression at the gastric body and pylorus, retained food in the proximal stomach, and could not easily be passed across the pyloric constriction; a nasojejunal feeding tube was placed under direct visualisation. Pre-operative biochemistry was unremarkable apart from hypokalaemia (potassium 2.78\u2005mmol\/L), which was corrected before surgery; serial bioelectrical impedance and hand-grip dynamometry suggested preserved muscle mass during prehabilitation. An open Rives\u2013Stoppa retrorectus mesh repair was performed; the intra-operative defect measured 5\u2009\u00d7\u200910\u2005cm (transverse\u2009\u00d7\u2009cranio-caudal) and the contents were viable. Recovery was uneventful. At the most recent review, he was asymptomatic with a full oral diet and regular bowel function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GOO from a stomach-containing paraumbilical hernia can occur in young patients with severe obesity, where chronically raised intra-abdominal pressure and progressive intra-sac extrusion of viscera through a stable but capacious defect, rather than ligamentous laxity, account for migration of the stomach into the sac. A high index of suspicion, multi-detector CT, formal volumetric loss-of-domain assessment, multidisciplinary optimisation, and retromuscular (Rives-Stoppa) repair offered satisfactory short-term resolution in this patient, with longer follow-up required to confirm durability. The case is reported in accordance with the CARE 2013 reporting guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1873927","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:47:31Z","timestamp":1782280051000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Giant paraumbilical hernia causing gastric outlet obstruction in a young man with class III obesity: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Guo Hou","family":"Loo","sequence":"first","affiliation":[{"name":"Upper Gastrointestinal and Metabolic Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng Xian","family":"Chan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhun Shen","family":"Tan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Ritza","family":"Kosai","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Metabolic Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1002\/bjs.11489","article-title":"Guidelines for treatment of umbilical and epigastric 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