Yonsei Med J.  2007 Jun;48(3):549-553. 10.3349/ymj.2007.48.3.549.

Traumatic Abdominal Wall Hernia (TAWH): A Case Study Highlighting Surgical Management

• Choi HJ
• Park KJ
• Lee HY
• Kim KH
• Kim SH
• Kim MC
• Kim YH
• Cho SH
• Jung GJ

• KMID: 724115
• DOI: http://doi.org/10.3349/ymj.2007.48.3.549

Abstract

We report a rare case of traumatic abdominal wall hernia (TAWH) caused by a traffic accident. A 47-year-old woman presented to the emergency room soon after a traffic accident. She complained of diffuse, dull abdominal pain and mild nausea. She had no history of prior abdominal surgery or hernia. We found a bulging mass on her right abdomen. Plain abdominal films demonstrated a protrusion of hollow viscus beyond the right paracolic fat plane. Computed tomography (CT) showed intestinal herniation through an abdominal wall defect into the subcutaneous space. She underwent an exploratory surgery, followed by a layer-by-layer interrupted closure of the wall defect using absorbable monofilament sutures without mesh and with no tension, despite the large size of the defect. Her postoperative course was uneventful.

Keyword

Traumatic abdominal wall hernia; primary closure

MeSH Terms

Abdominal Injuries/complications
Abdominal Wall/pathology/*surgery
Female
Hernia, Abdominal/etiology/radiography/*surgery
Humans
Middle Aged
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 Preoperative contrast enhanced CT scans. (A) Initial scout film shows bulging (arrow head) on right side of the abdomen and protrusion (circle) of the intestinal loop beyond the paracolic fat plane. (B) A huge abdominal wall defect without penetration of the skin. Note that the right colon and small bowel are herniated through the defect.

• 

  Fig. 2 Operative findings. (A) Herniation of the small bowel and right colon through the defect. (B) The skin and subcutaneous fat layer were intact but there was a large defect at the peritoneum, muscle and fascia. (C) The external oblique muscle was approximated with the fascia of the lateral rectus. (D) Complete reconstruction of the wall defect was carried out.

• 

  Fig. 3 The follow-up contrast enhanced CT scan in the postoperative 6th month shows neither hernia recurrence nor weakened abdominal wall layers.

Reference

1. Lane CT, Cohen AJ, Cinat ME. Management of traumatic abdominal wall hernia. Am Surg. 2003. 69:73–76.

2. Wood RJ, Ney AL, Bubrick MP. Traumatic abdominal hernia: a case report and review of the literature. Am Surg. 1988. 54:648–651.

3. Selby CD. Direct abdominal hernia of traumatic origin. JAMA. 1906. 47:1485–1486.

4. Damschen DD, Landercasper J, Cogbill TH, Stolee RT. Acute traumatic abdominal hernia: case reports. J Trauma. 1994. 36:273–276.

5. Dimyan W, Robb J, MacKay C. Handlebar hernia. J Trauma. 1980. 20:812–813.

6. Malangoni MA, Condon RE. Traumatic abdominal wall hernia. J Trauma. 1983. 23:356–357.

7. Clain A. Traumatic hernia. Br J Surg. 1964. 51:549–550.

8. Gill IS, Toursarkissian B, Johnson SB, Kearney PA. Traumatic ventral abdominal hernia associated with small bowel gangrene: case report. J Trauma. 1993. 35:145–147.

9. Shiomi H, Hase T, Matsuno S, Izumi M, Tatsuta T, Ito F, et al. Handlebar hernia with intra-abdominal extraluminal air presenting as a novel form of traumatic abdominal wall hernia: report of a case. Surg Today. 1999. 29:1280–1284.

10. Ganchi PA, Orgill DP. Autopenetrating hernia: a novel form of traumatic abdominal wall hernia--case report and review of the literature. J Trauma. 1996. 41:1064–1066.

11. Guly HR, Stewart IP. Traumatic hernia. J Trauma. 1983. 23:250–252.

12. Otero C, Fallon WF Jr. Injury to the abdominal wall musculature: the full spectrum of traumatic hernia. South Med J. 1988. 81:517–520.

13. Drago SP, Nuzzo M, Grassi GB. Traumatic ventral hernia: report of a case, with special reference to surgical treatment. Surg Today. 1999. 29:1111–1114.

14. Fraser N, Milligan S, Arthur RJ, Crabbe DC. Handlebar hernia masquerading as an inguinal haematoma. Hernia. 2002. 6:39–41.

15. Perez VM, McDonald AD, Ghani A, Bleacher JH. Handlebar hernia: a rare traumatic abdominal wall hernia. J Trauma. 1998. 44:568.

16. Kubalak G. Handlebar hernia: case report and review of the literature. J Trauma. 1994. 36:438–439.

17. Goliath J, Mittal V, McDonough J. Traumatic handlebar hernia: a rare abdominal wall hernia. J Pediatr Surg. 2004. 39:e20–e22.

18. Mahajna A, Ofer A, Krausz MM. Traumatic abdominal hernia associated with large bowel strangulation: case report and review of the literature. Hernia. 2004. 8:80–82.

19. Walcher F, Rose S, Roth R, Lindemann W, Mutschler W, Marzi I. Double traumatic abdominal wall hernia and colon laceration due to a pelvic fracture. Injury. 2000. 31:253–256.

20. Martinez BD, Stubbe N, Rakower SR. Delayed appearance of traumatic ventral hernia: a case report. J Trauma. 1976. 16:242–243.

21. Sahdev P, Garramone RR Jr, Desani B, Ferris V, Welch JP. Traumatic abdominal hernia: report of three cases and review of the literature. Am J Emerg Med. 1992. 10:237–241.

22. Vargo D, Schurr M, Harms B. Laparoscopic repair of a traumatic ventral hernia. J Trauma. 1996. 41:353–355.

23. Mancel B, Aslam A. Traumatic abdominal wall hernia: an unusual bicycle handlebar injury. Pediatr Surg Int. 2003. 19:746–747.

24. Santora TA, Roslyn JJ. Incisional hernia. Surg Clin North Am. 1993. 73:557–570.

25. Iinuma Y, Yamazaki Y, Hirose Y, Kinoshita H, Kumagai K, Tanaka T, et al. A case of a traumatic abdominal wall hernia that could not be identified until exploratory laparoscopy was performed. Pediatr Surg Int. 2005. 21:54–57.