Traumatic Abdominal Wall Hernia Research Articles

Endovascular treatment of traumatic pseudoaneurysm of the ileal branch of the superior mesenteric artery in a 9-year-old girl: Case report and literature review.

Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection. A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision. Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury. Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding. Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm. Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.

Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature

Abstract Traumatic abdominal wall hernia (TAWH) is a rare clinical occurrence, with only limited cases published since 1906. This type of hernia is primarily caused by low- or high-energy blunt force trauma, resulting in damage to abdominal wall musculature while the skin is intact. The diagnosis and management of TAWH poses a lot of challenges and complexities. Herein, we present a case of a 32-year-old male Saudi patient who sustained significant abdominal trauma as a driver involved in a front collision while wearing a seat belt. Upon arrival at the trauma center, the patient was hemodynamically stable and exhibited clinical signs of left flank bulge, seat belt sign, and abdominal bruising. First, a focused assessment with sonography for trauma (FAST) was performed, which revealed minimal free fluid in the abdomen. Subsequent contrast-enhanced IV computed tomography (CT) scan confirmed a 3.6-cm left lateral abdominal wall defect with herniation of short segments of the large and small bowel loops and adjacent subcutaneous fluid. Following initial observation, the patient developed signs of bowel obstruction. A repeat CT scan showed interval progression of the hernia, partial small bowel obstruction, and other concerning findings. An emergency laparoscopic exploration revealed a large defect at the left lumber region containing omentum and long segments of the small bowel with mild distension. The bowel and omentum were reduced. The surgical repair included herniorrhaphy and mesh placement. The patient recovered well and was discharged on the third postoperative day. This case underscores the importance of thorough evaluation and timely intervention in TAWHs. Rapid surgical management, aided by advanced imaging techniques, can lead to favorable outcomes even in complex cases involving bowel herniation and associated complications.

Road Traffic Accident Traumatic Vehicle Seat Belt Abdominal Wall Hernia

Traumatic abdominal wall hernia (TAWH) is a rare type of hernia with an incidence of about <1.5%, resulting from blunt abdominal trauma, which leads to an increase in the intra-abdominal pressure and rupture in the abdominal musculature and fascia with herniation of the abdominal organs into the defect. Most TAWH contained either a small bowel (69%) or a large bowel (36%), with 16% containing both. This condition is often not present as an isolated case, as 30% to 60% of the cases are accompanied by other intra-abdominal injuries. The typical manner of presentation is a tender subcutaneous swelling across the abdomen wall with overlaying bruising and ecchymosis. The radiological investigative modality of CT scan has the highest index of diagnosing accompanied intra-abdominal visceral injuries. We present a rare case of a 23-year-old male patient diagnosed with TAWH containing both small bowel and sigmoid colon associated with psoas hematoma caused by a seat belt postroad traffic accident (RTA).

Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study

Background Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. Methods A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. Results 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. Conclusions This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.

A western trauma association multicenter comparison of mesh versus non-mesh repair of blunt traumatic abdominal wall hernias

BackgroundBlunt traumatic abdominal wall hernias (TAWH) occur in <1 % of trauma patients. Optimal repair techniques, such as mesh reinforcement, have not been studied in detail. We hypothesize that mesh use will be associated with increased surgical site infections (SSI) and not improve hernia recurrence. Materials and methodsA secondary analysis of the Western Trauma Association blunt TAWH multicenter study was performed. Patients who underwent TAWH repair during initial hospitalization (1/2012–12/2018) were included. Mesh repair patients were compared to primary repair patients (non-mesh). A logistic regression was conducted to assess risk factors for SSI. Results157 patients underwent TAWH repair during index hospitalization with 51 (32.5 %) having mesh repair: 24 (45.3 %) synthetic and 29 (54.7 %) biologic. Mesh patients were more commonly smokers (43.1 % vs. 22.9 %, p = 0.016) and had a larger defect size (10 vs. 6 cm, p = 0.003). Mesh patients had a higher rate of SSI (25.5 % vs. 9.5 %, p = 0.016) compared to non-mesh patients, but a similar rate of recurrence (13.7 % vs. 10.5%, p = 0.742), hospital length of stay (LOS), and mortality. Mesh use (OR 3.66) and higher ISS (OR 1.06) were significant risk factors for SSI in a multivariable model. ConclusionMesh was used more frequently in flank TAWH and those with a larger defect size. Mesh use was associated with a higher incidence and risk of SSI but did not reduce the risk of hernia recurrence. When repairing TAWH mesh should be employed judiciously, and prospective randomized studies are needed to identify clear indications for mesh use in TAWH.

A Woman with Abdominal Pain After Lap-belt Trauma.

A 24-year-old female presented to the emergency department with diffuse abdominal pain after involvement as a restrained driver in a motor vehicle collision (MVC). Computed tomography of the abdomen revealed a traumatic abdominal wall hernia due to rectus wall rupture with complete bowel herniation. A traumatic abdominal wall hernia is a rare complication of blunt abdominal trauma that is typically associated with injury from a motorcycle handlebar but is more commonly seen after a MVC. It is important to consider this diagnosis when evaluating patients with abdominal pain after blunt abdominal trauma from either of these mechanisms.

Massive traumatic abdominal wall hernia in pediatric multitrauma in Australia: a case report

Traumatic abdominal wall hernia is a rare presentation, most commonly reported in the context of motor vehicle accidents and associated with blunt abdominal injuries and handlebar injuries in the pediatric population. A 13-year-old boy presented with multiple traumatic injuries and hemodynamic instability after a high-speed motor vehicle accident. His injuries consisted of massive traumatic abdominal wall hernia (grade 4) with bowel injury and perforation, blunt aortic injury, a Chance fracture, hemopneumothorax, and a humeral shaft fracture. Initial surgical management included partial resection of the terminal ileum, sigmoid colon, and descending colon. Laparostomy was managed with negative pressure wound therapy. The patient underwent skin-only primary closure of the abdominal wall and required multiple returns to theatre for debridement, dressing changes, and repair of other injuries. Various surgical management options for abdominal wall closure were considered. In total, he underwent 36 procedures. The multiple injuries had competing management aims, which required close collaboration between specialist clinicians to form an individualized management plan. The severity and complexity of this injury was of a scale not previously experienced by many clinicians and benefited from intrahospital and interhospital specialist collaboration. The ideal aim of primary surgical repair was not possible in this case of a giant abdominal wall defect.

A Case of Post Traumatic Abdominal Wall Hernia after Impact from Handlebar

A Case of Post Traumatic Abdominal Wall Hernia after Impact from Handlebar

Blunt Traumatic Abdominal Wall Hernias: An Indicator for Emergent Laparotomy?

Traumatic abdominal wall hernias (TAWH) are relatively uncommon; however, the shearing force that results in fascial disruption could indicate an increased risk of visceral injury. The aim of our study was to evaluate whether the presence of a TAWH was associated with intra-abdominal injury requiring emergent laparotomy. The trauma registry was queried over an 8-year period (7/2012-7/2020) for adult patients with blunt thoracoabdominal trauma diagnosed with a TAWH. Those patients who were identified with a TAWH and greater than 15years of age were included in the study. Demographics, mechanism of injury, ISS, BMI, length of stay, TAWH size, type of TAWH repair, and outcomes were analyzed. Overall, 38,749 trauma patients were admitted over the study period, of which 64 (.17%) had a TAWH. Patients were commonly male (n = 42, 65.6%); the median age was 39 years (range 16-79years) and a mean ISS of 21. Twenty-eight percent had a clinical seatbelt sign. Twenty-seven (42.2%) went emergently to the operating room, the majority for perforated viscus requiring bowel resection (n = 16, 25.0%), and 6 patients (9.4%) who were initially managed nonoperatively underwent delayed laparotomy. Average ventilator days was 14days, with a mean ICU LOS of 14days and mean hospital LOS of 18days. About half of the hernias were repaired at the index operation, 6 of which were repaired primarily and 10 with mesh. The presence of a TAWH alone was an indication for immediate laparotomy to evaluate for intra-abdominal injury. In the absence of other indications for exploration, nonoperative management may be safe.

Risk factors for recurrence in blunt traumatic abdominal wall hernias: A secondary analysis of a Western Trauma association multicenter study

BackgroundFew studies have investigated risk factors for recurrence of blunt traumatic abdominal wall hernias (TAWH). MethodsTwenty trauma centers identified repaired TAWH from January 2012 to December 2018. Logistic regression was used to investigate risk factors for recurrence. ResultsTAWH were repaired in 175 patients with 21 (12.0%) known recurrences. No difference was found in location, defect size, or median time to repair between the recurrence and non-recurrence groups. Mesh use was not protective of recurrence. Female sex, injury severity score (ISS), emergency laparotomy (EL), and bowel resection were associated with hernia recurrence. Bowel resection remained significant in a multivariable model. ConclusionFemale sex, ISS, EL, and bowel resection were identified as risk factors for hernia recurrence. Mesh use and time to repair were not associated with recurrence. Surgeons should be mindful of these risk factors but could attempt acute repair in the setting of appropriate physiologic parameters.

INCARCERATED ACUTE TRAUMATIC ABDOMINAL WALL HERNIA : A RARE ENTITY

Acute traumatic abdominal wall hernia is a rare type of hernia that occurs after a low or high velocity impact of the abdominal wall against a blunt object only few cases have been reported in literature. We report a case where a high velocity impact due to roadside accident caused a traumatic abdominal wall hernia in a 48-year-old male patient. The physical examination ndings revealed the presence of traumatic abdominal wall with gut lying just below the fat of anterior abdominal wall which was which was conrmed on USG. Patient was managed by exploratory laparotomy with resection and ileo-ileal anastomosis. The post operative period was uneventful. It is important to emphasize the importance of the physical examination in such cases to make early diagnosis. Urgent surgical intervention is recommended to avoid wound and bowel related complications.

WE7.10 Traumatic abdominal wall hernia and CT missed severe intra-abdominal injuries

Abstract Despite traumatic abdominal wall hernia (TAWH) being a rare entity, the incidence of associated intra-abdominal injuries is extremely common. With only few cases published, TAWH remains a diagnostic as well as a therapeutic challenge. We present an obese 47-year-old female, front seat passenger, that was transferred to our hospital from a neighbouring DGH with a diagnosis of TAWH after a 30mph road traffic collision. On arrival, she was haemodynamically stable, abdominal examination showed a large hernia, extensive bruising but the abdomen was otherwise unremarkable. The CT performed before transfer showed a large hernia but no obvious other injury, no free fluid or gas was identified. Hernia repair was planned for the following day. Overnight there was a transient period of hypotension responsive to transfusion of multiple RBC units. The surgical approach was over the hernia site. Within the sac a transected end of small bowel was found and so laparotomy was undertaken, which demonstrated a bucket handle mesenteric tear of terminal ileal mesentery with infarction of 20 cm of small bowel and a complete transverse tear of mid sigmoid colon and its mesentery. Remarkably there was no intraperitoneal contamination from either injury. Our clinical case highlights that although the CT scan is the gold standard for initial diagnosis of intra-abdominal injuries in TAWH, these can still be missed. To note that failure to make a timely diagnosis can result in delayed complications with significant morbidity and mortality. Therefore, a high clinical suspicion, despite of negative imaging, is crucial to provide appropriate management.

A Rare Traumatic Event: Description of a Parailiac Hernia in a Young Female following Blunt Trauma

Traumatic abdominal wall hernias are a rare event following blunt trauma. This case report details the course of a traumatic left parailiac hernia in an 18-year-old female initially diagnosed on CT imaging. The timing of repair in such hernias is largely debated, and this patient’s repair was delayed by significant operative intra-abdominal injuries, recurrent orthopaedic surgeries, and an infected hematoma at the hernia site. Ultimately, it was repaired primarily three months after the initial trauma. At most recent follow-up, there was no recurrence of the hernia but the patient was dissatisfied with cosmesis. The cumulative literature is lacking data on the treatment of traumatic hernias and there is no consensus as to the ideal timing and method of repair; therefore, the strategies described in this case report of a successful traumatic hernia repair are important to establishing guidelines for such trauma.

Post-traumatic Synchronous Twin Inter-muscular Abdominal and Diaphragmatic Hernias: A Rare Presentation

Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.

An Australian Approach to Managing Traumatic Abdominal Wall Hernias

Traumatic abdominal wall hernias (TAWH) occur in less than one percent of trauma presentations. In the absence of clinical guidelines, management is centre-specific and largely dependent on surgeon experience. This study describes the management of TAWH in a high volume Australian trauma centre. A single centre retrospective cohort study was performed. Adults with TAWH as a result of blunt trauma, between January 2016 and July 2020, were included. Primary outcomes were the mechanism of injury, presentation, timing of repair, and operative technique used. A total of 16 patients (63% male; median age 36 years; median Injury Severity Score [ISS] 19.5) were identified. In total, 75% were the result of a motor vehicle accident. A total of 13 patients (81%) underwent repair. Eight patients received repair during emergency exploration undertaken for concurrent injuries. Three patients had a delayed repair during index admission, and two patients had an elective repair. Primary tissue repair was performed in seven patients. Mesh repair was used in six. Patients were followed for a median of 55.5 days. One patient had a recurrence of hernia following primary repair. This local series demonstrates that traumatic abdominal wall hernias may be successfully repaired during index admission using tissue or mesh techniques.

Traumatic abdominal wall hernia in a patient with diastasis recti.

Traumatic abdominal wall hernia in a patient with diastasis recti.

Traumatic Abdominal Wall Hernia Repair with Dermal Autograft within a Morel-Lavallée Lesion

Summary:Morel-Lavallée lesions and traumatic abdominal wall hernias seldom present together and have no standardized guidelines for treatment. We present a unique case of a traumatic abdominal wall hernia present within a patient’s abdominal Morel-Lavallée lesion, which was reduced and repaired with a dermal autograft. This is a novel approach to repairing a rare and unusual injury. The literature suggests that tension-free repairs with mesh should be used on delayed repairs of traumatic abdominal wall hernias. However, some advocate for primary repairs due to an up to 50% increased risk of wound infection in these injuries, even without the use of mesh. Although infection rates with the use of biologic mesh (acellular dermal matrices) in a contaminated field are lower than that of synthetic mesh, infections still occur and tend to be higher in repairs without mesh. The lack of foreign material and innate immunogenicity of the patient’s own dermis may theoretically decrease the risk of infection compared with other commercially-available and biologically-derived products. The patient is a 47-year-old woman who was in a motor vehicle accident with prolonged extrication time. She was hospitalized for approximately 6 months due to extensive injuries, but had no further complications from her Morel-Lavallée lesion or repair of her traumatic abdominal wall hernia with her own dermis.

Intestinal herniation through anterior abdominal wall-sequalae of coffee machine burst: a rare case report and review of literature

Evisceration of gut loops following blunt trauma abdomen leading to abdominal wall disruption is a rare entity. These injuries come under umbrella term of traumatic abdominal wall hernia (TAWH). The most common mode of trauma has been road side accidents. Many case reports of bicycle handle injuries leading to evisceration have been reported. But, TAWH occurring after injury due to explosion of household accessories has not been reported. The present case describes such condition and the management that followed.

Traumatic abdominal wall hernia: a rare and often missed diagnosis in blunt trauma

Traumatic abdominal wall hernia: a rare and often missed diagnosis in blunt trauma

A combined laparoscopic and open delayed repair of a rare traumatic abdominal wall hernia

Introduction: Traumatic abdominal wall hernias (TAWHs) are uncommon and result from a high-energetic blunt trauma to the abdomen. These hernias are not always apparent in initial trauma evaluation. No consensus exists regarding optimal timing and surgical approach. Case Presentation: A 68-year-old Caucasian woman was involved as a passenger in a high-energetic head-on collision motor vehicle accident. In the initial assessment a sternal fracture, four rib fractures, a small pneumothorax, and a medial malleolus fracture were found. A small abdominal wall hernia was missed. Six months later she presents with a painful mass in her left flank. Computed tomography (CT) showed a large hernia containing colon. An elective hybrid repair was done. Laparoscopically, a preperitoneal mesh was placed. Afterward, using open access, the abdominal wall musculature was re-fixated on the iliac crest. Discussion: Emergent surgical management of TAWH is often preferred due to high incidence of associated intra-abdominal lacerations. These settings are not always favorable for mesh placement. Some data suggest a higher recurrence rate for hernias without mesh augmentation and repair within the acute posttraumatic period. Conservative management poses the risk of incarceration and hernia defect enlargement. A delayed repair can be considered if the patient is hemodynamically stable, no associated visceral lacerations are present and the defect is large enough to reduce the risk of incarceration. It has the advantage of mesh placement in healthy tissue. Conclusions: A delayed laparoscopic repair seems a safe and valid option allowing larger mesh placement. Additional fascia closure of muscle fixation can be done granting more reinforcement and smaller incision needs and thus less postoperative pain.