Epigastric and Umbilical Hernia; Work Relatedness and Return to Work
A 30 years old man with abdominal wall hernia and recurrence after first surgery was referred for work relatedness evaluation. He was working in an industrial electrical panel manufacturing company on the outskirts of Tehran, the capital of Iran, as an electrical assembler from 2002 to 2009. Carrying pieces between 20 to 100 kg with or without trolleys was a part of his job duties. The results of pre-employment and annual periodic examinations which had been performed by occupational medicine specialists were normal. Occupational hygienist reported insufficient training, supervision, control of health hazards and protective equipments. The worker had three work accidents in his occupational history.\nIn the latest, May 2008, he was referred to hospital because of protruded mass followed by sudden sever pain in his abdomen while lifting a transformer and had an emergency open surgery with anatomic repair of defect without any bowel resection. His surgeon wrote for employer that: “The patient had epigastric and umbilical hernia with some necrosis in mesenteric and abdominal wall fat due to heavy duties of work”. Postoperative clinic visit evaluation was normal. After discharge, the surgeon advised two months off work and then six months away from heavy duties or lifting over five kilograms. The patient returned to work two month later but his employer forced him to lift things as before. Six months after the first surgery, the worker agreed with another surgery because of abdominal pain due to recurrence of hernia and employer dismissed him. He had not history of professional exercise, smoking or any other disease. In this case, regardless of being right or wrong in the surgeon’s clinical performance and subsequent career advice, employer was incriminated only for recurrences of hernia because of early usage of worker against physician opinion. Finally, after second surgery with prosthetic repair of defect, the worker returned to his work with lifelong limitations for heavy lifting without any decrease in his wage.