because of serious complications such as rupture and strangulation of the hernia content , incarceration of the umbilical hernia is a significant surgical condition ( 1 ) . the small bowel , the omentum and the large bowel are frequently seen in the hernia sac . , we present a patient with an incarcerated umbilical hernia caused by a giant ovarian tumor . a 61-yr - old woman was admitted to the emergency department with symptoms of sudden abdominal pain , nausea , vomiting and painful swelling in a previously diagnosed umbilical hernia . she had had severe abdominal pain and the sensation of a mass for the previous 2 hr . because of her low socioeconomic status , she had no history of routine healthcare , and she had a history of uncontrolled hypertension . on examination , she had a 1510 cm , irreducible , purple - colored umbilical hernia , and there was extreme tenderness and hyperemia on hernia . because of the incarcerated umbilical hernia and possible strangulation of the hernia content , the patient underwent an urgent operation without any diagnostic evaluation . during the operation , a partial omental infarct and an intraabdominal tumor 1 ) . a partial omentectomy was performed , and abdominal incision was extended from pubis to the epigastrium . a large , multilocular , left ovarian cyst , which extended from the transverse colon to rectovesical space , was observed ( fig . total abdominal hysterectomy and bilateral salphingo - oophorectomy were performed with no complications . during the operation , the resected tumor measured as 252316 cm and weighed 3,680 g. on microscopic examination , the tumor was uniform and composed of pale oval cells with prominent grooves ( coffee bean appearance ) . the diagnosis of a granulosa cell tumor was supported by the immunohistochemical expression of inhibin in the neoplastic cells ( fig . 3 ) . because she had high blood pressure , the patient was followed - up in the intensive care unit . about 2 weeks after discharge , she underwent second operation ( ie , a staging operation ) that used the same incision . an omentectomy , a paraaortic and pelvic lymphadenectomy , peritoneal washing , cytology analysis , and peritoneal biopsies were done at that time , and no metastases were found . after the second operation , combination chemotherapy with bleomycin ( 10 mg / m ) , cisplatin ( 100 mg / m ) and etoposide ( 100 mg / m ) was begun . a granulosa cell tumor of the ovary is an uncommon neoplasm derived from granulosa cells . although it can be seen at any age , it occurs most commonly during the perimenopausal and early postmenopausal years . the incidence of granulosa cell tumors has been reported to be 0.4 to 1.7 per 100,000 women ( 2 ) . postoperative chemotherapy is given for patients with granulosa cell tumors that are of stages ii , iii , and iv . however , some patients with large stage - i tumors ( ie , those > 10 - 15 cm ) , a high mitotic index , tumor rupture or all or any combination of these can be considered for adjuvant chemotherapy ( 2 ) . this is why we gave adjuvant chemotherapy to our patient : because of the high risk of recurrence . however the benefit of adjuvant chemotherapy for high - risk stage - i patients has not been supported by prospective randomized studies ( 2 ) . the umbilicus is a site at which intra - abdominal cancer metastases that are inoperable can be seen , beacuse the tumors appear as a characteristic sister mary joseph 's nodule . the small bowel , the omentum , and the large bowel are frequently seen within the hernia sac ( 3 ) . rare cases including gallstones after a laparoscopic cholecystectomy , perforated acute appendicitis , strangulated meckel 's diverticulum , myomatous uterus , and incarcerated pregnant uterus in the umbilicus have been reported ( 3 ) . millar and associates reported a patient similar to ours : theirs was the first report of a reducible umbilical hernia with an ovarian tumor ( 4 ) . but ours is the first report of an incarcerated umbilical hernia with a giant ovarian tumor . uluda and associates reported incarceration of an umbilical hernia during pregnancy because of a sessile fibroid ( 1 ) , and wong ( 5 ) reported a uterine fibroid presenting as an incarcerated umbilical hernia during pregnancy . in conclusion , intra - abdominal tumors presenting as incarcerated or strangulated hernias are extremely rare but do occasionally occur . if it is not suspected before surgery , a careful exploration is needed to identify the content . in such cases , diagnostic biopsies , mass resections , or both , with primary hernia repairs definitive surgery for the primary disease should be planned after doing a detailed evaluation of the patient and consulting with the related surgical branches in elective surgery services .
we report a rare case of a giant ovarian tumor presenting as an incarcerated umbilical hernia . 
 a 61-yr - old woman was admitted to the hospital with severe abdominal pain , an umbilical mass , nausea and vomiting . on examination , a large , irreducible umbilical hernia was found . 
 the woman underwent an urgent operation for a possible strangulated hernia . 
 a large , multilocular tumor was found . 
 the tumor was excised , and a total abdominal hysterectomy and bilateral salphingo - oophorectomy were performed . 
 the woman was discharged 6 days after her admission . 
 this is the first report of incarcerated umbilical hernia containing a giant ovarian tumor within the sac .