Strangulated small bowel obstruction (SBO) is a life-threatening surgical emergency associated with bowel ischemia, necrosis, and perforation. Umbilical hernias, although commonly benign, may rarely progress to incarceration and strangulation, significantly increasing patient morbidity and mortality. We present the case of a 33-year-old morbidly obese female with acute umbilical pain, bilious vomiting, and an irreducible umbilical mass. Clinical findings, elevated inflammatory markers, and computed tomography imaging confirmed an incarcerated umbilical hernia with suspected bowel strangulation. Emergency laparotomy revealed strangulated small bowel within the hernia sac, requiring bowel resection and a surgical anastomosis. The abdominal wall was closed primarily with non-absorbable suture. This case highlights the diagnostic and operative challenges associated with strangulated SBO, particularly in obese patients and in the presence of iatrogenic complications. It also emphasizes the importance of early diagnosis, prompt surgical intervention, and the role of advanced imaging modalities such as CT in improving patient outcomes.

Keywords: Bowel strangulation; Strangulated hernia; Umbilical hernia