written informed consent was obtained from the patient for publication of this case report and accompanying images .
highlightsa thorough history and examination is required in all patients in order to draw attention to cases in which there may be a significant underlying pathology.contemplation of causes of raised intra - abdominal pressure , such as malignancy , should be considered in patients with multiple hernia or additional symptoms such as weight loss.there remains a question over whether macroscopically normal hernia sacs should be sent for histological assessment . 
 histological assessment should be mandatory in patients with macroscopic abnormalities or in those with red flag symptoms .