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Traumatic disruption of musculature and fascia of anterior abdominal wall due to blunt trauma
Contrast-enhanced, multiplanar CT
Common locations include iliac crest region in seat belt injuries and lower abdomen (lateral to rectus sheath or inguinal region)
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
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
Traumatic abdominal wall hernia (TAWH)
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