Alisan Fathalizadeh, MD, MPH, Lawrence N Cetrulo, MD, Simran Randhava, MD, Parkson Leung, MD, MSc. Albert Einstein Medical Center
A traumatic abdominal wall hernia (TAWH) is a rare entity characterized by disruption of the musculature and fascia of the abdominal wall with preservation of the overlying skin layer following blunt trauma.The elasticity of the abdominal wall is protective against blunt trauma such that the force becomes transmitted to internal organs thereby sparing the abdominal wall. Thus, although blunt traumas have been on a rise, the development of TAWH remains very rare.
A 28 year-old male previously healthy male presented to the emergency department following an auto versus motorcycle accident. He was ejected from his motorcycle and likely skid on his abdomen. Upon presentation his primary survey was intact and he was hemodynamically stable. He had multiple musculoskeletal injuries, anterior chest and abdominal road rash, abdominal tenderness on physical exam. He had an equivocal focused abdominal sonography for trauma (FAST) exam and ultimately underwent a CT abdomen/pelvis demonstrating a traumatic ventral hernia as well as hemoperitoneum for which was taken to the operating room. All of the fascial and muscle layers in the midline overlying the area of the previous defect were found to be disrupted with bowel and mesentery present under the intact skin layer. The source of the hemoperitoneum was identified as an isolated hematoma in the small bowel mesentery in the area of small bowel that had herniated through the fascial defect. This area of small bowel and the injured mesentary were resected. The fascia was ultimately closed and a vac was placed in the subcutaneous layer.
Although a rare entity, familiarity with TAWHs is imperativative to allow for appropriate management. Most literature advocate early repair of traumatic abdominal wall hernias in that a failure to diagnose may result in incarceration or strangulation. Thus, despite the rare nature of TAWHs, early recognition and surgical management is imperative in the care of such patients.