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7-13: Traumatic Abdominal Hernia

Kevin S. Barlotta; Lawrence B. Stack; Kevin J. Knoop

Clinical Summary

Blunt traumatic abdominal hernia is defined as herniation through disrupted musculature and fascia associated with adequate trauma, without skin penetration, and no evidence of a prior hernial defect at the site of injury. This occurs when a considerable blunt force is distributed over a surface area large enough to prevent skin penetration but small enough to cause a focal defect in the underlying fascia or muscle wall. Most of these injuries are due to seat belt injuries in motor vehicle crashes; handlebar injuries are the 2nd most common cause. Up to 44% of these patients require bowel resection.

FIGURE 7.37

Traumatic Abdominal Wall Hernia. This 5-year-old boy suffered a traumatic hernia from a handlebar injury. (Photo contributor: Lawrence B. Stack, MD.)

In a young patient with a Traumatic Abdominal Wall Hernia, there is a circular injury with bleeding and swelling, a few inches below the navel. In a patient with a traumatic abdominal wall hernia caused by bicycle handlebars, there is marked abdominal swelling and bleeding just below the navel.
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In a young patient with a Traumatic Abdominal Wall Hernia, there is a circular injury with bleeding and swelling, a few inches below the navel. In a patient with a traumatic abdominal wall hernia caused by bicycle handlebars, there is marked abdominal swelling and bleeding just below the navel.
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Contrast-enhanced CT of the abdomen and pelvis is the preferred diagnostic study for the evaluation of a traumatic abdominal hernia. Ultrasound may play a limited role in the diagnosis of abdominal wall hernia.

Management and Disposition

Identification and treatment of life-threatening associated injuries take priority over the hernia. The hernial defect should be repaired after the patient has been stabilized.

Pearls

  1. Abdominal hernia due to blunt trauma is a rare injury, most frequently due to seat belt injuries in motor vehicle crashes.

  2. Contrast-enhanced CT scan is the preferred diagnostic study for abdominal wall hernias.

FIGURE 7.38

CT Scan, Abdominal Wall Hernia. Abdominal contents are seen extruding through a fascial defect. (Photo contributor: Lawrence B. Stack, MD.)

A C T Scan in an axial cut of an Abdominal Wall Hernia shows the abdominal contents extruding through a fascial defect, appearing as dark patches.
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