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Ceballos Esparragón J, Dagnesses Fonseca J, Marín García J, Petrone P. Abdominal hernias secondary to non-penetrating trauma. A systematic review. Cir Esp 2024:S2173-5077(24)00169-8. [PMID: 39009304 DOI: 10.1016/j.cireng.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024]
Abstract
Traumatic abdominal wall hernia (TAWH) is a protrusion of contents through a defect in the abdominal wall as a consequence of a blunt injury. The objective of this review was to describe demographic and clinical aspects of this rare pathology, identifying the optimal moment for surgical intervention, evaluating the need to use mesh, and analyzing the effectiveness of surgical treatment. Thus, a systematic review using PubMed, Embase, and Scopus databases was carried out between January 2004 and March 2024. Computed tomography is the gold-standard imaging test for diagnosis. Open surgery is generally the preferred approach, particularly in emergencies. Acute TAWH can be treated by primary suture or mesh repair, depending on local conditions, while late cases usually require mesh.
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Affiliation(s)
| | - Javier Dagnesses Fonseca
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Jordi Marín García
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, New York, USA.
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2
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Poppe M, Duarte CM, Fernandes S, Goulão J. Traumatic abdominal wall hernia in childhood: a bicycle handlebar injury. BMJ Case Rep 2024; 17:e260806. [PMID: 38782431 DOI: 10.1136/bcr-2024-260806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
A female patient in her middle childhood presented to the paediatric emergency room (ER) after a bicycle accident with an abdominal impact on the bicycle handlebar. On physical examination, a painful ecchymosis on the upper left quadrant was the only abnormal finding. Abdominal ultrasound showed no intra-abdominal lesions, and the patient was discharged home after 24 hours under monitoring. Nine days after the accident, she returned to the ER due to the emergence of an abdominal mass around the area of impact. Abdominal examination detected a tender non-fluctuating mass on the epigastric and left hypochondrium, and abdominal ultrasound revealed a muscle and aponeurosis disruption of the rectus muscle, with fat herniation and cytosteatonecrosis. A conservative approach was chosen, with ambulatory follow-up. One month after the accident, the patient was asymptomatic, no abdominal mass was palpable, and an abdominal CT showed a reduction of the muscle disruption and hernial content.
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Affiliation(s)
- Mariana Poppe
- Pediatrics, Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | - João Goulão
- Pediatric Surgery, Hospital Beatriz Ângelo, Loures, Portugal
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3
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Vieira B, Melo A, Gomes C, Lajut L, Ribeiro A, Fernandes U, Guidi G, Leal C, Pinto-de-Sousa J. Handlebar hernia-unusual complication from blunt trauma. J Surg Case Rep 2022; 2022:rjac195. [PMID: 35673539 PMCID: PMC9167937 DOI: 10.1093/jscr/rjac195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/16/2022] [Indexed: 12/07/2022] Open
Abstract
Handlebar hernia is a rare entity, mainly resulting from blunt abdominal trauma with a sudden deceleration mechanism. Diagnosis of handlebar at admission may be difficult because the rupture of abdominal wall layers often is not clinically recognized in the emergency department, which requires a high degree of suspicion to identify theses lesions. It is very important to rule out the presence of intra-abdominal injuries, and in adults, surgical repair is needed. Herein, the case of an adult man who presented to the emergency department with blunt abdominal trauma caused by a motorcycle handlebar is described.
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Affiliation(s)
- Bruno Vieira
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Ana Melo
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Carina Gomes
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Leandro Lajut
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Artur Ribeiro
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Urânia Fernandes
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Gonçalo Guidi
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Clara Leal
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - João Pinto-de-Sousa
- Department of Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
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4
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Hafezi N, Raymond JL, Mayo ED, Rouse TM, Billmire DF, Gray BW. Traumatic abdominal wall hernias in children: A case for early exploration. J Pediatr Surg 2021; 56:1004-1008. [PMID: 32753277 DOI: 10.1016/j.jpedsurg.2020.06.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma (BAT). We examined a series of patients suffering TAWH to evaluate its frequency, rate of associated concurrent intraabdominal injuries (CAI) and correlation with CT, management and outcomes. METHODS A Level 1 pediatric trauma center trauma registry was queried for children less than 18 years old suffering TAWH from BAT between 2009 and 2019. RESULTS 9370 patients were admitted after BAT. TAWH was observed in 11 children, at incidence 0.1%. Eight children (73%) were male, at mean age 10 years, and mean ISS of 16. Six cases (55%) were because of MVC, three (27%) impaled by a handlebar or pole, and two (18%) dragged under large machinery. Seven (64%) had a CAI requiring operative or interventional management. Patients with CAI were similar to those without other injury, with 20% and 50% CT scan sensitivity and specificity for detection of associated injury, respectively. Five patients had immediate hernia repair with laparotomy for repair of intraabdominal injury, three had delayed repair, two have asymptomatic unrepaired TAWH, and one resolved spontaneously. CONCLUSIONS Children with TAWH have high rates of CAI requiring operative repair. CT scans have low sensitivity and specificity for detecting associated injuries. A high suspicion of injury and low threshold for exploration must be maintained in TAWH cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Niloufar Hafezi
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA
| | - Jodi L Raymond
- Riley Trauma Program, Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Drive, Suite 1925, Indianapolis, IN 46202, USA
| | - Erin D Mayo
- Riley Trauma Program, Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Drive, Suite 1925, Indianapolis, IN 46202, USA
| | - Thomas M Rouse
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA; Riley Trauma Program, Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Drive, Suite 1925, Indianapolis, IN 46202, USA
| | - Deborah F Billmire
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA; Riley Trauma Program, Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Drive, Suite 1925, Indianapolis, IN 46202, USA
| | - Brian W Gray
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA; Riley Trauma Program, Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Drive, Suite 1925, Indianapolis, IN 46202, USA.
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5
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Theodorou CM, Stokes SC, Beres AL. Traumatic Abdominal Wall Hernia in Children: A Systematic Review. J Surg Res 2021; 262:181-189. [PMID: 33601272 DOI: 10.1016/j.jss.2020.12.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature to describe injuries, management, and outcomes. MATERIALS AND METHODS Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed, Web of Science, Embase, and Google Scholar was performed to identify English-language publications of blunt TAWH in patients <18 y old. Conflicts were resolved by consensus. Data were collected on demographics, associated injuries, management, and outcomes. RESULTS A total of 71 articles were reviewed with 100 cases of TAWH. A total of 82.5% of patients were male, and the median age was 9 y old (range 2-15). Injury by bicycle handlebars was most common (72%) followed by motor vehicle collision (14%). Forty patients had intraabdominal injuries, most commonly bowel (70%) or mesentery (37.5%). Rate of intraabdominal injury was significantly higher in patients with injuries due to nonbicycle handlebar injuries when compared with bicycle handlebar injuries (60.7% versus 33.3%, P = 0.02). Most patients were managed operatively (85%), most commonly via laparotomy (68/85, 80%), with six laparoscopic repairs and five laparoscopic converted to open repairs. There were three reported complications and no recurrences over a median of follow-up of 5 mo in patients who underwent repair. CONCLUSIONS Pediatric TAWH is a rare injury with a high rate of intraabdominal injuries, particularly when due to high-impact mechanisms such as motor vehicle collision. Although open repair is more commonly performed, laparoscopic repair has been described with success. Recurrence rates appear low, but follow-up has been short term.
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Affiliation(s)
- Christina M Theodorou
- Department of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California.
| | - Sarah C Stokes
- Department of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California
| | - Alana L Beres
- Department of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California
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Aggelidou M, Deftereos S, Foutzitzi S, Oikonomou P, Kambouri K. Handlebar hernia in children: a conservative approach. Case report and literature review. J Surg Case Rep 2018; 2018:rjy075. [PMID: 29692885 PMCID: PMC5909425 DOI: 10.1093/jscr/rjy075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/12/2018] [Indexed: 11/14/2022] Open
Abstract
Handlebar hernias are very rare and occur after a blunt abdominal trauma by a bicycle handlebar or a handlebar-shape object. As a result the abdominal wall musculature and fascia are disrupted while the skin is still intact. A good history of the injury and physical examination are usually enough to pose a diagnosis. We report the case of bicycle-handlebar hernia in a 6-year-old boy who presented to our emergency department because of a reducible swelling above the left iliac crest after falling from his bicycle 3 days ago. The patient was treated conservatively with a weekly follow-up. Four weeks later the muscle disruption was healed. In pediatric patient in the absence of internal organ injuries, a handlebar hernia can successfully be managed conservatively.
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Affiliation(s)
- Maria Aggelidou
- Department of Pediatric Surgery, Faculty of Medicine, Alexandroupoli University Hospital, Democritus University of Thrace, Dragana 68100, Alexandroupoli, Greece
| | - Savas Deftereos
- Department of Radiology, Faculty of Medicine, Alexandroupoli University Hospital, Democritus University of Thrace, Dragana 68100, Alexandroupoli, Greece
| | - Soultana Foutzitzi
- Department of Radiology, Faculty of Medicine, Alexandroupoli University Hospital, Democritus University of Thrace, Dragana 68100, Alexandroupoli, Greece
| | - Panagoula Oikonomou
- Second Department of Surgery, Faculty of Medicine, Alexandroupoli University Hospital, Democritus University of Thrace, Dragana 68100, Alexandroupoli, Greece
| | - Katerina Kambouri
- Department of Pediatric Surgery, Faculty of Medicine, Alexandroupoli University Hospital, Democritus University of Thrace, Dragana 68100, Alexandroupoli, Greece
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7
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Adakal O, Adamou H, Magagi IA, Koini M, Halidou M, Habou O. ["Handlebar" hernia: a rare type of traumatic parietal hernia]. Pan Afr Med J 2017; 25:110. [PMID: 28292073 PMCID: PMC5325498 DOI: 10.11604/pamj.2016.25.110.10808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022] Open
Abstract
Un patient de 20 ans avec une notion de chute sur le guidon d’une moto remontant à 28 jours, était admis pour douleurs abdominales aux urgences chirurgicales. L’examen clinique retrouvait un point d’impact circulaire au niveau de l’hypochondre gauche avec en regard une tuméfaction douloureuse, irréductible et non impulsive aux efforts de toux. Le diagnostic d’une hernie pariétale traumatique étranglée était posé. L’abord chirurgical par laparotomie médiane mettait en évidence une brèche pariétale avec incarcération d’une partie de l’épiploon qui était nécrosée. L’épiploon nécrosé était reséqué et une raphie de la brèche était réalisée. Les suites post-opératoires étaient simples et le patient sortait à j5.
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Affiliation(s)
- Ousseini Adakal
- Département de Chirurgie et Spécialités Chirurgicales, Centre Hospitalier Régional de Maradi, Niger
| | - Harissou Adamou
- Département de Chirurgie et Spécialités Chirurgicales, Hôpital National de Zinder, Niger
| | - Ibrahim Amadou Magagi
- Département de Chirurgie et Spécialités Chirurgicales, Hôpital National de Zinder, Niger
| | - Moussa Koini
- Département de Chirurgie et Spécialités Chirurgicales, Centre Hospitalier Régional de Maradi, Niger
| | - Maazou Halidou
- Département de Chirurgie et Spécialités Chirurgicales, Hôpital National de Zinder, Niger
| | - Oumarou Habou
- Département de Chirurgie et Spécialités Chirurgicales, Hôpital National de Zinder, Niger
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8
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Volpe A, Virgone C, Gamba P. Successful conservative management of handlebar hernia in children. Pediatr Int 2017; 59:105-106. [PMID: 28102633 DOI: 10.1111/ped.13110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/04/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Volpe
- Pediatric Surgery, Department of Women's and Children's Health, University-Hospital of Padua, Padua, Italy
| | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University-Hospital of Padua, Padua, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University-Hospital of Padua, Padua, Italy
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9
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What we know about management of traumatic abdominal wall hernia: review of the literature and case report. Int Surg 2016; 100:233-9. [PMID: 25692423 DOI: 10.9738/intsurg-d-13-00239.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Traumatic abdominal wall hernia (TAWH) is an uncommon form of hernia caused by blunt traumatic disruption of the abdominal wall musculature/fascia and abdominal organ herniation. Diagnosis of TAWH is challenging and requires a high level of suspicion. This form of hernia seems to be underrepresented in the English-language medical literature. There is currently no consensus on the optimal management for TAWH. In this article, we discuss the management of a 36-year-old motorcycle driver who was involved in a road traffic accident. On evaluation at our trauma center, he was found to have TAWH. Diagnostic criteria, imaging modalities and different management options for TAWH will be discussed.
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10
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Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Upasani A, Bouhadiba N. Paediatric abdominal wall hernia following handlebar injury: should we diagnose more and operate less? BMJ Case Rep 2013; 2013:bcr2012008501. [PMID: 23606382 PMCID: PMC3644890 DOI: 10.1136/bcr-2012-008501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Traumatic abdominal wall hernia following handlebar injury can be easily missed and is thus underreported. A 12-year-old boy presented with handlebar injury to the left upper quadrant of his abdomen. Except for a localised swelling, thought to be related to a haematoma, he was haemodynamically stable. CT revealed an abdominal wall defect with herniating fat that was not evident clinically and was also missed on immediate ultrasound examination. As there were no associated injuries and the abdominal wall defect was small without any herniating bowel loops, masterly inactivity was observed. After 6 weeks, the swelling has disappeared completely and there is progressive reduction in the size of the defect.
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Affiliation(s)
- Anand Upasani
- Department of Paediatric Surgery, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
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12
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Rathore A, Simpson BJ, Diefenbach KA. Traumatic abdominal wall hernias: an emerging trend in handlebar injuries. J Pediatr Surg 2012; 47:1410-3. [PMID: 22813805 DOI: 10.1016/j.jpedsurg.2012.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 11/26/2022]
Abstract
Handlebar injuries are well described in pediatric patients and are frequently associated with internal injuries, including the "classic" duodenal hematoma and solid organ injuries. Before this report, traumatic handlebar hernias were considered rare. They occur when the end of the handlebar (often bare or lacking protective equipment) applies a significant force to a focal area of the abdomen leading to a disruption in the underlying muscle fibers and fascia while sparing the overlying skin. Such nonpenetrating injuries may present with subtle clinical signs and should always be considered in the differential diagnosis. Imaging, with the use of computed tomographic scan or ultrasound will confirm the diagnosis as well as identify any associated injuries. The management plan usually requires surgical exploration and repair of the defect. The prognosis is favorable presuming that there is no significant underlying injury. In this report, we present a series of 5 patients with traumatic handlebar hernia-the most frequently-occurring injury in our series-and review concurrent associated injuries.
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Affiliation(s)
- Animesh Rathore
- Department of Surgery, Section of Pediatric Surgery, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT 06511, USA.
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13
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Traumatic abdominal wall hernia after blunt abdominal trauma caused by a handlebar in children: A well-visualized case report. Surgery 2012; 151:899-900. [DOI: 10.1016/j.surg.2011.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/17/2011] [Indexed: 11/15/2022]
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14
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Singal R, Gupta R, Mittal A, Gupta A, Singal RP, Singh B, Gupta S, Mittal G. Delayed presentation of the traumatic abdominal wall hernia; dilemma in the management - review of literature. Indian J Surg 2012; 74:149-56. [PMID: 23542824 DOI: 10.1007/s12262-011-0365-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 10/26/2011] [Indexed: 12/07/2022] Open
Abstract
Traumatic abdominal wall hernia is a rare entity, and an uncommon type of abdominal wall hernia as far as the etiology is concerned. It is caused by blunt trauma and disrupts the fascial layers, but does not disrupt the elastic skin. In this study, we report the case of a 60-year-old female, diagnosed with traumatic abdominal wall hernia with delayed presentation. In this case, herniation of the bowels was present through the defect in the left iliac region. She was surgically well-managed. During the follow-up of 1 year, there was no recurrence. In the Western medical literature, only a few cases have been reported, especially with intra-abdominal injuries. Confusion still exists in the management of such a disease as to whether to treat the condition at an early or later stage.
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Affiliation(s)
- Rikki Singal
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana India ; C/o Dr Kundan Lal Hospital, Ahmedgarh, Distt-Sangrur, Pin code-148021 Punjab India
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15
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Yan J, Wood J, Bevan C, Cheng W, Wilson G. Traumatic abdominal wall hernia--a case report and literature review. J Pediatr Surg 2011; 46:1642-5. [PMID: 21843736 DOI: 10.1016/j.jpedsurg.2011.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 03/27/2011] [Accepted: 04/05/2011] [Indexed: 11/19/2022]
Abstract
We present a case report and comprehensive literature review of pediatric traumatic abdominal wall hernia caused by a blow from a bicycle handlebar. Traumatic abdominal wall hernia is a rare complication of bicycle handlebar injury. An awareness of this entity will help prevent a missed diagnosis. Operative repair is met with good outcome.
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Affiliation(s)
- Jennifer Yan
- Department Paediatric Surgery, Monash Children's, Monash Medical Centre, Clayton 3168 Victoria,
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16
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Singal R, Dalal U, Dalal AK, Attri AK, Gupta R, Gupta A, Naredi B, Kenwar DB, Gupta S. Traumatic anterior abdominal wall hernia: A report of three rare cases. J Emerg Trauma Shock 2011; 4:142-5. [PMID: 21633587 PMCID: PMC3097568 DOI: 10.4103/0974-2700.76832] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 09/17/2010] [Indexed: 12/07/2022] Open
Abstract
Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma. Associated intra-abdominal injuries are infrequent. In this study, we are reporting three cases, diagnosed as abdominal wall hernia associated with herniation of bowel loops due to blunt trauma. In one case, injury of the herniated bowel was seen. In western medical literature, only few cases have been reported especially with intra-abdominal injuries.
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Affiliation(s)
- Rikki Singal
- Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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17
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Ajisaka H, Okura S, Wakasugi M. Traumatic Abdominal Wall Hernia: A Case Report of High-Energy Type without Surgical Repair. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2011; 4:35-8. [PMID: 22084611 PMCID: PMC3201103 DOI: 10.4137/ccrep.s7425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Repair of traumatic abdominal wall hernia (TAWH) has been reported to be necessary. Reported here is one case of TAWH without repair. A 27-year-old man was accidentally sandwiched between a rock and a truck and admitted to our emergency department. There was a swelling of 10 cm in the right upper quadrant of the abdomen. The enhanced computed tomographic scan demonstrated a large abdominal wall muscular defect, transverse colon protrusion, and the presence of subcutaneous emphysema at the site. Based on these findings, lacerated transverse colon entrapped in TAWH was diagnosed. The patient underwent emergency laparotomy for laceration of the transverse colon, duodenum and pancreas, and open book fracture of the pelvis. Repair of the hernia was not performed because of the possibility of abscess formation by stool contamination. However, the hernia disappeared and the patient is doing well without recurrence of hernia 16 months after injury.
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Affiliation(s)
- Hideyuki Ajisaka
- Department of Emergency and Critical Care Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
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18
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Traumatic abdominal wall hernia in two adults: a case series. J Med Case Rep 2009; 3:7324. [PMID: 19830187 PMCID: PMC2726548 DOI: 10.4076/1752-1947-3-7324] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 01/22/2009] [Indexed: 11/10/2022] Open
Abstract
Introduction Traumatic hernia of the abdominal wall is a rare entity. A large proportion of reported cases are in children with a particular type of injury, i.e. from a handlebar injury. In adults, the presentation can vary substantially and the diagnosis is difficult. We present two cases in adults, with widely varying presentations and management. Case presentations A 40-year-old woman from rural north India presented with a low-velocity blunt injury to the lower abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin, and was hemodynamically stable. An emergency mesh repair of the defect was performed, and she recovered well. A 38-year-old man from rural north India presented with blunt trauma to the abdomen following a motor vehicle accident. He was stable, with a central abdominal parietal wall swelling and bruising. A computed tomography scan revealed herniation of bowel loops in the area with minor intra-abdominal injuries. A laparotomy, resection-anastomosis of the ischemic bowel, and primary repair of the defect was performed and he recovered well. Conclusion Following blunt abdominal trauma, particularly high-velocity injuries, a high index of suspicion must be reserved for parietal wall swellings, as missed hernias in this setting have a high risk of strangulation. Computed tomography is the best aid to diagnosis. Management of each case needs to be individualized.
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A hidden danger of childhood trauma: bicycle handlebar injuries. Surg Today 2009; 39:572-4. [PMID: 19562443 DOI: 10.1007/s00595-008-3931-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 08/26/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate childhood bicycle handlebar injuries. METHODS We evaluated retrospectively 14 patients who presented with bicycle handlebar injuries within a 3-year period. Bicycle injuries not caused by the handlebar were excluded. RESULTS The mean age of the patients was 8.8 +/- 2 years (range, 5-12 years) and 79% were boys. The injuries comprised gastrointestinal perforation in 21%, traumatic abdominal hernia in 21%, and spleen laceration in 14%. The three children with intestinal perforation and the one with a penetrating abdominal injury underwent surgery, whereas the others were treated medically. An isolated traumatic abdominal hernia resolved spontaneously. There was no mortality. CONCLUSIONS Although bicycle handlebar injuries occur at relatively low speeds, the transfer of energy from the end of the handlebar, with a small cross-sectional area, to a small field leads to intra-abdominal injuries that are more severe than predicted. Thus, bicycle handlebar injuries should be considered as a serious intraabdominal injury until proven otherwise.
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Litton K, Izzidien AY, Hussien O, Vali A. Conservative management of a traumatic abdominal wall hernia after a bicycle handlebar injury (case report and literature review). J Pediatr Surg 2008; 43:e31-2. [PMID: 18405697 DOI: 10.1016/j.jpedsurg.2007.12.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 11/28/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
Abstract
'Handlebar hernia' is the name given to a specific type of traumatic abdominal wall hernia (TAWH). It is an uncommon injury, caused by impact of the abdominal wall against a blunt object, often bicycle handlebars. We present a case of handelbar hernia, discuss its investigation and treatment and suggest that immediate surgical repair may not always be required.
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Affiliation(s)
- Karen Litton
- Department of Surgery, Prince Charles Hospital Merthyr Tydfil CF479DT, Cardiff, Wales, UK
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