Delayed Presentation of a Traumatic Lumbar Hernia Caused by Seat Belt

Abstract

Background: Traumatic abdominal wall hernia is seldom seen. Rarer still is delayed presentation of a traumatic lumbar hernia. Expedient diagnosis and early surgical intervention are the hallmarks of management. Case Study: A 37-year-old restrained male driver was involved in a high-speed rollover motor vehicle accident. Initial trauma evaluation, including abdominal ultrasound, was negative. 2 weeks later the patient presented to our institution with progressively worsening right flank pain. An abrasion (seat belt sign) was noticed above the iliac crest. Abdominal CT scan revealed a right lumbar hernia at the iliac crest. Intraoperatively, a 7-cm hernia defect was identified and repaired. The patient had an uneventful recovery and remains symptom-free at 6-month follow-up. Discussion: Traumatic abdominal wall hernia secondary to blunt trauma is a relatively uncommon injury. The fascia defect is usually located at anatomic weak points in the lower abdominal wall lateral to the rectus sheath or in the inguinal region. Up to two thirds of patients with large traumatic abdominal wall hernias have associated intraabdominal injuries. This is the rare case of a traumatic hernia in the inferior lumbar triangle. It emphasizes the need for a high index of suspicion for this injury and also underscores the importance of choosing appropriate adjunctive modalities to facilitate diagnosis.