Traumatic abdominal wall hernia caused by a low fall
Background: Traumatic abdominal wall hernias (TAWH) are uncommon injuries classically associated with high-energy blunt traumatic mechanisms. Motor vehicle collisions cause the highest proportion of all TAWH. Literature is currently limited, with some debate existing over surgical management strateg...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-02-01
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| Series: | Trauma Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352644021001771 |
| _version_ | 1828136643904667648 |
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| author | Obteene Azimi-Ghomi John D. Ehrhardt, Jr Shaikh Hai |
| author_facet | Obteene Azimi-Ghomi John D. Ehrhardt, Jr Shaikh Hai |
| author_sort | Obteene Azimi-Ghomi |
| collection | DOAJ |
| description | Background: Traumatic abdominal wall hernias (TAWH) are uncommon injuries classically associated with high-energy blunt traumatic mechanisms. Motor vehicle collisions cause the highest proportion of all TAWH. Literature is currently limited, with some debate existing over surgical management strategies. Case presentation: A 67-year-old man presented after falling from a short step stool while landscaping his yard. On exam, an exquisitely tender lateral flank mass was present with peristaltic movement. CT imaging revealed a TAWH with incarcerated large and small bowel. He was taken to the OR for exploratory laparotomy and mesh hernia repair. The patient was discharged on the third postoperative day with no untoward complications. Discussion: This patient’s mechanism and injury pattern are together a rare combination. Exam findings and radiologic technologies are used to hone the clinical index of suspicion for TAWH. Traumatic abdominal wall defects can have unusual anatomic borders, not always obeying well-known hernia patterns. In this case, the potential space for visceral herniation was created by an 11th rib fracture with associated avulsion of the oblique musculature. Operative approach can be open or laparoscopic, however concomitant injuries directly influence surgical management. Evidence for mesh versus primary repair for TAWH is conflicted by the current literature. Conclusions: Nearly any amount of blunt abdominal force can cause TAWH. For wall defects with bowel herniation caused directly by trauma, the safest approach may involve exploratory laparotomy. Future multi-center studies may be able to distinguish TAWH repair strategies based on herniation through old defects versus newly-created abdominal wall injuries. |
| first_indexed | 2024-04-11T18:07:33Z |
| format | Article |
| id | doaj.art-69a4b25e43bf4f8e826d00cdc960bd7f |
| institution | Directory Open Access Journal |
| issn | 2352-6440 |
| language | English |
| last_indexed | 2024-04-11T18:07:33Z |
| publishDate | 2022-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Trauma Case Reports |
| spelling | doaj.art-69a4b25e43bf4f8e826d00cdc960bd7f2022-12-22T04:10:17ZengElsevierTrauma Case Reports2352-64402022-02-0137100572Traumatic abdominal wall hernia caused by a low fallObteene Azimi-Ghomi0John D. Ehrhardt, Jr1Shaikh Hai2Corresponding author at: 11750 SW 40th St, Miami, FL 33175, USA.; Division of Trauma and Acute Care Surgery, Department of Surgery, Kendall Regional Medical Center, Miami, FL, USADivision of Trauma and Acute Care Surgery, Department of Surgery, Kendall Regional Medical Center, Miami, FL, USADivision of Trauma and Acute Care Surgery, Department of Surgery, Kendall Regional Medical Center, Miami, FL, USABackground: Traumatic abdominal wall hernias (TAWH) are uncommon injuries classically associated with high-energy blunt traumatic mechanisms. Motor vehicle collisions cause the highest proportion of all TAWH. Literature is currently limited, with some debate existing over surgical management strategies. Case presentation: A 67-year-old man presented after falling from a short step stool while landscaping his yard. On exam, an exquisitely tender lateral flank mass was present with peristaltic movement. CT imaging revealed a TAWH with incarcerated large and small bowel. He was taken to the OR for exploratory laparotomy and mesh hernia repair. The patient was discharged on the third postoperative day with no untoward complications. Discussion: This patient’s mechanism and injury pattern are together a rare combination. Exam findings and radiologic technologies are used to hone the clinical index of suspicion for TAWH. Traumatic abdominal wall defects can have unusual anatomic borders, not always obeying well-known hernia patterns. In this case, the potential space for visceral herniation was created by an 11th rib fracture with associated avulsion of the oblique musculature. Operative approach can be open or laparoscopic, however concomitant injuries directly influence surgical management. Evidence for mesh versus primary repair for TAWH is conflicted by the current literature. Conclusions: Nearly any amount of blunt abdominal force can cause TAWH. For wall defects with bowel herniation caused directly by trauma, the safest approach may involve exploratory laparotomy. Future multi-center studies may be able to distinguish TAWH repair strategies based on herniation through old defects versus newly-created abdominal wall injuries.http://www.sciencedirect.com/science/article/pii/S2352644021001771Traumatic abdominal wall herniaLow-energy blunt traumaIncarcerated herniaMesh hernia repair |
| spellingShingle | Obteene Azimi-Ghomi John D. Ehrhardt, Jr Shaikh Hai Traumatic abdominal wall hernia caused by a low fall Trauma Case Reports Traumatic abdominal wall hernia Low-energy blunt trauma Incarcerated hernia Mesh hernia repair |
| title | Traumatic abdominal wall hernia caused by a low fall |
| title_full | Traumatic abdominal wall hernia caused by a low fall |
| title_fullStr | Traumatic abdominal wall hernia caused by a low fall |
| title_full_unstemmed | Traumatic abdominal wall hernia caused by a low fall |
| title_short | Traumatic abdominal wall hernia caused by a low fall |
| title_sort | traumatic abdominal wall hernia caused by a low fall |
| topic | Traumatic abdominal wall hernia Low-energy blunt trauma Incarcerated hernia Mesh hernia repair |
| url | http://www.sciencedirect.com/science/article/pii/S2352644021001771 |
| work_keys_str_mv | AT obteeneazimighomi traumaticabdominalwallherniacausedbyalowfall AT johndehrhardtjr traumaticabdominalwallherniacausedbyalowfall AT shaikhhai traumaticabdominalwallherniacausedbyalowfall |