Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Traumatic Abdominal Wall Hernia
KEY FACTS
Terminology
-
Traumatic disruption of musculature and fascia of anterior abdominal wall due to blunt trauma
Imaging
-
Contrast-enhanced, multiplanar CT
-
Common locations include iliac crest region in seat belt injuries and lower abdomen (lateral to rectus sheath or inguinal region)
Pathology
-
Most hernias develop due to combination of sudden increase in intraabdominal pressure, direct force of traumatic impact, acceleration-deceleration shear injury, and compressive force of seat belt
-
High-energy injuries: Motor vehicle accidents constitute ~ 50% of cases, with seat belt use increasing risk
- –
"High-riding" seat belt incorrectly placed over abdomen increases risk (muscle avulsion from iliac crest)
- –
Other traumatic injuries are common (~ 80%), with up to 50% of patients suffering other abdominal injuries requiring surgery
- –
-
Low-energy injuries (most common in children): Impact by small blunt object (such as bicycle handlebar, i.e., handlebar hernia)
- –
Hernias can develop after minor trauma in children
- –
-
Clinical Issues
-
May be overlooked clinically at time of injury and often diagnosed due to hernia-related complications
-
Only 22% of patients in 1 series had TAWH diagnosed clinically, making CT essential to diagnosis
-
Complications: Incarceration; bowel strangulation, perforation, and ischemia
-
-
Peak incidence in children < 10 years of ag,e due to handlebar injuries
-
2nd most common age group is 20-50 years, due to motor vehicle accidents
-
-
Treatment: Delayed repair of hernia usually performed 6-8 weeks following high-energy injuries to allow primary tissue damage to subside
Axial CECT demonstrates small bowel and colon
herniating through a traumatic abdominal wall defect. At surgery, several segments of small bowel had serosal tears and avulsions, requiring resection.
herniating through a traumatic abdominal wall defect. At surgery, several segments of small bowel had serosal tears and avulsions, requiring resection.
Axial CECT demonstrates a traumatic lumbar hernia, with herniated abdominal fat covered only by the latissimus dorsi muscle
. Also noted is infiltration of the intraabdominal fat
adjacent to the hernia. At surgery, a serosal tear of the descending colon was identified.
. Also noted is infiltration of the intraabdominal fat adjacent to the hernia. At surgery, a serosal tear of the descending colon was identified.
Axial CECT demonstrates a large amount of hypoenhancing small bowel
herniated through a traumatic hernia of the right abdominal wall. Active arterial bleeding
is evident. Much of the herniated bowel was not viable at the time of surgery.
herniated through a traumatic hernia of the right abdominal wall. Active arterial bleeding is evident. Much of the herniated bowel was not viable at the time of surgery.
Axial CECT shows disruption of the abdominal wall muscles
in the left lower quadrant, with the muscles avulsed from their attachment to the iliac crest. Note the presence of adjacent subcutaneous hematoma
. This is a typical example of a seat belt injury.
in the left lower quadrant, with the muscles avulsed from their attachment to the iliac crest. Note the presence of adjacent subcutaneous hematoma . This is a typical example of a seat belt injury.
TERMINOLOGY
Abbreviations
-
Traumatic abdominal wall hernia (TAWH)
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here
