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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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Navarro-Nuño DE, de Jesús Valdez-Pereira H, Cervantes-Nuño AV, Dorado-Hernández E, Torres-Salazar QL. Traumatic abdominal wall hernia: Case report of atypical origin. Int J Surg Case Rep 2023; 110:108780. [PMID: 37678033 PMCID: PMC10510060 DOI: 10.1016/j.ijscr.2023.108780] [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: 08/14/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Traumatic abdominal wall hernia (TAWH) is an injury that occurs after an abdominal wall blunt trauma consisting of fasciomuscular rupture and does not present skin penetration. Documenting unique and rare clinical cases, such as traumatic hernia without skin penetration, enriches the medical literature and provides valuable information to identify innovative and optimised approaches for the treatment of similar cases in the future. CASE PRESENTATION 48-year-old female with no significant medical history presented to the emergency room after being directly hit by a 1200 kg vehicle while standing in the street. Clinical examination revealed a TAWH with total elevation and total loss of insertion of all abdominal wall muscles on the right side, and no involvement of the overlying skin secondary to the mechanism of trauma. The patient agreed to surgical management after being thoroughly informed about the procedure. Surgical exploration was performed with the patient in a lateral position, and the incision was made over the hernia sac. A monopolar electrocautery was used to expose the iliac crest and fully visualize the defect before drilling through the iliac crest. Soft macroporous polypropylene mesh repair was guided through the iliac crest and abdominal wall using a suture and secured with knots. The patient showed a satisfactory and favorable progress. DISCUSSION AND CONCLUSIONS The present surgical technique is recommended for atypical cases of high-strength TAWH.
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Affiliation(s)
- Damaris Estefania Navarro-Nuño
- Regional Hospital "Dr. Valentín Gómez Farías", Institute of Security and Social Services for State Workers, v. Soledad Orozco 203, El Capullo, 45100 Zapopan, Jal
| | - Hernán de Jesús Valdez-Pereira
- Regional Hospital "Dr. Valentín Gómez Farías", Institute of Security and Social Services for State Workers, v. Soledad Orozco 203, El Capullo, 45100 Zapopan, Jal
| | - Ana Violeta Cervantes-Nuño
- Regional Hospital "Dr. Valentín Gómez Farías", Institute of Security and Social Services for State Workers, v. Soledad Orozco 203, El Capullo, 45100 Zapopan, Jal
| | - Emmanuel Dorado-Hernández
- Regional Hospital "Dr. Valentín Gómez Farías", Institute of Security and Social Services for State Workers, v. Soledad Orozco 203, El Capullo, 45100 Zapopan, Jal
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Herrera-Toro HT, Flórez-Arango N. Hernias traumáticas de la pared abdominal en pediatría: serie de tres casos. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Las hernias traumáticas de la pared abdominal son una entidad de muy rara ocurrencia en niños, con pocos casos descritos. Son lesiones causadas por trauma cerrado cuando las fuerzas resultantes del trauma no tienen la suficiente energía para romper la piel, pero son suficientes para producir una disrupción de las fibras musculares y la fascia.
Métodos. Se presentan tres casos clínicos de niños con hernias traumáticas, el primero tipo I y los otros dos, tipo II, cuyo diagnóstico y tratamiento quirúrgico se llevaron a cabo por el servicio de cirugía pediátrica en un hospital de alto nivel de atención en Colombia.
Resultados. Los tres pacientes fueron llevados a manejo quirúrgico sin prótesis, el primero por abordaje abierto y los otros dos por cirugía videoasistida, con buena evolución y sin recidivas en el seguimiento.
Discusión. Las hernias traumáticas de la pared abdominal son más frecuentes en varones, como en nuestros casos, y del lado derecho. El diagnóstico de este tipo de hernias es clínico y se apoya en imágenes, teniendo en cuenta que no hay antecedente de hernia en la región afectada. El tratamiento es quirúrgico, pero es controversial el momento del mismo y el uso de materiales protésicos, puesto que existe la posibilidad de recidiva en los primeros meses en los casos de reparo primario.
Conclusión. A pesar de la rareza de esta entidad, presentamos tres pacientes pediátricos a quienes se les realizó diagnóstico y manejo quirúrgico tempranos, con buena evolución y seguimiento a más de tres años.
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Azimi-Ghomi O, Ehrhardt JD, Hai S. Traumatic abdominal wall hernia caused by a low fall. Trauma Case Rep 2022; 37:100572. [PMID: 34977320 PMCID: PMC8686031 DOI: 10.1016/j.tcr.2021.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Obteene Azimi-Ghomi
- Division of Trauma and Acute Care Surgery, Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - John D Ehrhardt
- Division of Trauma and Acute Care Surgery, Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Shaikh Hai
- Division of Trauma and Acute Care Surgery, Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
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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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Traumatic Abdominal Wall Hernia in Children by Handlebar Injury: When to Suspect, Scan, and Call the Surgeon. Pediatr Emerg Care 2020; 36:e534-e537. [PMID: 28441239 DOI: 10.1097/pec.0000000000001153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Traumatic abdominal wall hernias (TAWHs) can be defined as a herniation through disrupted musculature and fascia associated with blunt trauma. They are seen in approximately 1% of patients with blunt abdominal trauma. Data on TAWH in the pediatric population are very limited and principally based on case reports and a few case series. Past reports have indicated that the presence of the "handlebar sign" confers an increased risk of internal injury. Concomitant internal injuries are reported with an incidence between 25% and 70%, and occult hernias may also occur and are usually detected only by abdominal computed tomography scan and ultrasonography. The treatment of TAWH consists in surgical exploration through closure of the defect. We describe 2 cases of TAWH due to blunt impact by bicycle handlebars that occurred in our department with a brief literature review. Our objectives are to describe the variable clinical presentations and management of these events. We hope to provide a useful tool for the clinician to increase early clinical suspicion and detection of this insidious injury.
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Simplified Repair of Traumatic Iliac Crest Flank Hernias with Mesh Strips. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2970. [PMID: 32802663 PMCID: PMC7413785 DOI: 10.1097/gox.0000000000002970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Abstract
Traumatic abdominal wall hernias are rare injuries resulting from blunt abdominal trauma. Traditional approaches have included both open and laparoscopic approaches, with placement of large meshes with giant overlaps. Perhaps the most technically difficult aspect of these repairs is fixating the abdominal wall to the iliac crest. The senior author has developed a method of repair using 2-cm strips of mesh. In this article, we present a description of 4 patients treated with this technique.
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Chowdhury TK, Alam MA, Rahman MM, Khastagir R, Khan R. Traumatic abdominal wall hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Vu T, Klinkner DB. Traumatic abdominal wall hernia with evisceration secondary to handlebar injury. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shukla A, Verma V, Lal Kapoor K, Gupta B, Chaudhry R. Handlebar Hernia with Triple Herniation and Perforation: A Case Report and Literature Review. Bull Emerg Trauma 2018; 6:257-261. [PMID: 30090824 PMCID: PMC6078476 DOI: 10.29252/beat-060313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Blunt trauma abdomen is a very common entity but traumatic abdominal wall hernia is not that common. Herniation through abdominal wall usually occurs following trauma with seat belt, motor cycle, bicycle handle bar etc. Handlebar hernia is a less known variety of traumatic abdominal wall hernia as a consequence of injury with handlebar of a bicycle. It is difficult to diagnose and one should have high index of suspicion. Management in traumatic abdominal wall hernia is individualized based on various factors. We herein present an interesting case of a14-year-old boy, who sustained blunt trauma abdomen from bicycle handlebar leading to triple herniation and perforation of the small bowel and hematoma of the mesentery. Patient was resuscitated and operated with a favorable outcome. Blunt trauma abdomen is a very common and the possibility of traumatic abdominal wall hernia should always be borne in mind.
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Affiliation(s)
- Ankit Shukla
- General Surgeon, Civil Hospital Palampur, Kangra, Himachal Pradesh (Pin 176061), India
| | - Varun Verma
- General Surgeon, Civil Hospital Palampur, Kangra, Himachal Pradesh (Pin 176061), India
| | - Krishan Lal Kapoor
- Anesthesiologist, Civil Hospital Palampur, Kangra, Himachal Pradesh (Pin 176061), India
| | - Bhanu Gupta
- Anesthesiologist, Civil Hospital Palampur, Kangra, Himachal Pradesh (Pin 176061), India
| | - Rajesh Chaudhry
- Department of General Surgery, Dr Rajendra Prasad Government Medical College Kangra at Tanda Himachal Pradesh (Pin 176001), India
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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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Abstract
Traumatic abdominal wall hernias due to blunt abdominal trauma in pediatric patients can pose a diagnostic challenge because of spontaneous hernia reduction. Ultrasonography may be superior to computed tomography for this indication in some cases because of the ability to dynamically and repeatedly assess the area of injury. Herniation can be induced or exaggerated via Valsalva maneuvers, which can facilitate its detection during dynamic assessment. We present the case of a 3-year-old boy who sustained blunt abdominal trauma, with a resultant abdominal wall hernia that was diagnosed using point-of-care ultrasound imaging. This hernia was not visualized with computed tomography, and point-of-care ultrasonography expedited admission for operative repair.
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Tianyi FL, Agbor VN, Njim T. Motorbike-handlebar hernia - a rare traumatic abdominal wall hernia: a case report and review of the literature. J Med Case Rep 2017; 11:87. [PMID: 28359296 PMCID: PMC5374574 DOI: 10.1186/s13256-017-1245-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background Handlebar hernias are very rare and arise following a sudden force from a handle-like object impacting a focal area of the abdomen, which results in a disruption of the underlying abdominal muscle and fascia without necessarily disrupting the overlying skin. Other than a reducible swelling on the abdominal wall, the physical examination of such patients is usually unremarkable and the diagnosis could easily be missed. Case presentation An 8-year-old Cameroonian boy with no significant past history presented to our emergency service with a tender left flank swelling following a road traffic accident. He was knocked down by a motorbike with resulting impact of the handlebar on his abdomen. A handlebar hernia was diagnosed on the basis of a reducible abdominal swelling with a positive cough impulse. A herniorrhaphy was done the following day after resuscitation and his postoperative period was uneventful. Conclusions Handlebar hernias, although rare, should be suspected when patients present with an abdominal swelling following blunt abdominal trauma involving a handlebar-like object. A good history and physical examination are usually enough to pose an early diagnosis of handlebar hernia. Management typically involves surgical intervention to prevent complications. The timing and surgical approach should be decided on a case-by-case basis.
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Affiliation(s)
| | | | - Tsi Njim
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxfordshire, UK.,Health and Human Development Research Group (2HD), Douala, Cameroon
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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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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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Gillam EV, Mathieu A, Lacourt M. Mesh repair of a large traumatic lateral abdominal wall hernia in an 8-day-old foal. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- E. V. Gillam
- Clinique Vétérinaire de la Côte Fleurie; Deauville France
| | - A. Mathieu
- Pool House Equine Clinic; Lichfield Staffordshire UK
| | - M. Lacourt
- Clinique Vétérinaire de la Côte Fleurie; Deauville France
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Hirose T, Ogura H, Kiguchi T, Mizushima Y, Kimbara F, Shimazaki J, Shiono S, Yamamura H, Wakai A, Takegawa R, Matsumoto H, Ohnishi M, Shimazu T. The risk of pediatric bicycle handlebar injury compared with non-handlebar injury: a retrospective multicenter study in Osaka, Japan. Scand J Trauma Resusc Emerg Med 2015; 23:66. [PMID: 26382735 PMCID: PMC4574182 DOI: 10.1186/s13049-015-0146-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/25/2015] [Indexed: 11/12/2022] Open
Abstract
Background Bicycle accidents are one of the major causes of unintentional traumatic injury in childhood. The purpose of this study was to examine characteristics and risks of handlebar injury in childhood. Methods We conducted a more than 5-year retrospective survey of patients under 15 years of age with bicycle-related injuries admitted to eight urban tertiary emergency centers in Osaka, Japan. Patients were divided into the direct-impact handlebar injury (HI) group and the non-handlebar injury (NHI) group. Results The HI group included 18 patients and the NHI group included 308 patients. Median Injury Severity Score (ISS) in the HI group was 9. Injury sites included the chest, 2 (chest bruise, 1; tracheal injury, 1) and abdomen, 16 (hepatic injury, 6; pancreatic injury, 2; duodenal injury, 1; splenic injury, 1; small intestinal injury, 1; retroperitoneal hemorrhage, 1; renal injury, 1; abdominal wall musculature injury, 2; bladder injury, 1; and perineal laceration, 1). There were no significant differences in age, sex, ISS, and prognosis between the two groups. However, significant differences were seen in the abdominal median Abbreviated Injury Scale (AIS) score, which was higher in the HI group (3 vs 0, p < 0.01), and in the head median AIS score, which was higher in the NHI group (0 vs 2, p < 0.01). As mechanisms of injury, falling while riding a bicycle occurred significantly more frequently in the HI group (17 [94.4 %] vs 65 [21.1 %], p < 0.01). Direct transportation from the scene of the accident occurred significantly more often in the NHI group (5 [27.8 %] vs 255 [82.8 %], p < 0.01), whereas transfer from another hospital occurred significantly more frequently in the HI group (11 [61.1 %] vs 45 [14.6 %], p < 0.01). Conclusions Handlebar injuries in children have significant potential to cause severe damage to visceral organs, especially those in the abdomen.
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Affiliation(s)
- Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takeyuki Kiguchi
- Department of Emergency Medicine, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
| | - Yasuaki Mizushima
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku-orai kita, Izumisano, 598-8577, Japan.
| | - Futoshi Kimbara
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka, 565-0862, Japan.
| | - Junya Shimazaki
- Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka, 543-0035, Japan.
| | - Shigeru Shiono
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, 3-4-13 Nishiiwata, Higashiosaka City, Osaka, 578-0947, Japan.
| | - Hitoshi Yamamura
- Department of Trauma and Critical Care Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Akinori Wakai
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka, 540-0006, Japan.
| | - Ryosuke Takegawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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18
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Talutis SD, Muensterer OJ, Pandya S, McBride W, Stringel G. Laparoscopic-assisted management of traumatic abdominal wall hernias in children: case series and a review of the literature. J Pediatr Surg 2015; 50:456-61. [PMID: 25746707 DOI: 10.1016/j.jpedsurg.2014.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic abdominal wall hernia (TAWH) is defined as herniation through a disrupted portion of musculature/fascia without skin penetration or history of prior hernia. In children, TAWH is a rare injury. OBJECTIVE The objectives of this study were to report our experience with different management strategies of TAWH in children and to determine the utility of laparoscopy. DESIGN/METHOD A retrospective chart review of all children treated by pediatric surgery at our institution for TAWH in a 5year interval was performed. Data were collected on mechanism of injury, initial patient presentation, surgical management, and outcomes. RESULTS We present 5 cases of traumatic abdominal wall hernia; 3 were managed using laparoscopic assistance. One patient was managed nonoperatively. All patients recovered without complications and were asymptomatic on follow up. CONCLUSION Traumatic abdominal wall hernias require a high index of suspicion in the cases of blunt abdominal trauma. Laparoscopy is useful mainly as a diagnostic modality, both to evaluate the hernia and associated injuries to intraabdominal structures. Its use may facilitate repair through a smaller incision. Conservative management of TAWH may be appropriate in select cases where there is a low risk of bowel strangulation.
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Affiliation(s)
- Stephanie D Talutis
- Department of General Surgery, Boston University, 88 East Newton Street, C515, Boston, MA, 02118, USA.
| | - Oliver J Muensterer
- Division of Pediatric Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Medical Arts Pavilion, Room 4th Floor, Bronx, NY 10467, USA
| | - Samir Pandya
- Division of Pediatric Surgery, New York Medical College, Maria Fareri Children's Hospital, Skyline A14, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Whitney McBride
- Division of Pediatric Surgery, New York Medical College, Maria Fareri Children's Hospital, Skyline A14, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Gustavo Stringel
- Division of Pediatric Surgery, New York Medical College, Maria Fareri Children's Hospital, Skyline A14, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
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19
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Isolated jejunal perforation following bicycle handlebar injury in adults: a case report. Case Rep Emerg Med 2013; 2013:678678. [PMID: 23984116 PMCID: PMC3748403 DOI: 10.1155/2013/678678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/18/2013] [Indexed: 11/17/2022] Open
Abstract
The small intestine is the third in frequency intraperitoneal organ which is injured after blunt trauma of the abdomen. In most of the cases, this type of injuries is accompanied by other injuries, which make it more difficult to diagnose. Failure of diagnosis and delay in treating these injuries significantly increase the morbidity and mortality of these patients. Abdominal visceral injuries after flipping the handlebar of the bike are common in children. Such injuries can cause injury to both solid and hollow abdominal viscera. Unlike children, adults' abdominal visceral injuries after flipping the bike's handlebar are extremely rare. A 25-year-old man was admitted to our department due to progressively abdominal pain after an accident with the handlebar of his bike. The subsequent CT scan after per os administration of contrast medium revealed the presence of free intraperitoneal contrast. It is a rare case of jejunal perforation after flipping the handlebar of the bicycle which was treated by partial removal of the injured part of jejunum and end-to-end anastomosis. To the best of our knowledge this is the first time we describe such an injury with this mechanism to an adult.
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20
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Ghosh SC, Nolan GJ, Simpson RR. A concealed small bowel perforation in an adult secondary to bicycle handlebar trauma. Ann R Coll Surg Engl 2013; 95:e69-70. [PMID: 23676803 DOI: 10.1308/003588413x13511609957894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic abdominal wall hernia (TAWH) secondary to bicycle handlebar is a rare injury. The majority of the literature describes abdominal wall herniation in children. We present a rare case of TAWH in an adult with a concealed small bowel perforation. Although clinical examination in conjunction with computed tomography can exclude the majority of solid organ injuries, small bowel injuries can often be missed. Our case initially revealed a serosal tear in the small bowel but, on close inspection, a separate 3mm perforation was identified, hidden in the small bowel mesentery. We strongly support a low threshold for operative intervention if there is any suspicion. Moreover, we stress the importance of meticulous examination during laparotomy as this injury could have been easily missed, resulting in potential morbidity or mortality in a patient sustaining such an injury.
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Affiliation(s)
- S C Ghosh
- Department of Surgery, Gosford Hospital, PO Box 361, Gosford, NSW 2250, Australia.
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21
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Liasis L, Tierris I, Lazarioti F, Clark CC, Papaconstantinou HT. Traumatic abdominal wall hernia. J Trauma Acute Care Surg 2013; 74:1156-62. [DOI: 10.1097/ta.0b013e318283d88d] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Traumatic spigelian hernia due to handlebar injury in a child: a case report and review of literature. Indian J Surg 2012; 75:404-6. [PMID: 24426630 DOI: 10.1007/s12262-012-0734-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 09/10/2012] [Indexed: 11/27/2022] Open
Abstract
Traumatic abdominal wall hernia is a rare clinical entity despite the high incidence of blunt abdominal trauma. In children, traumatic abdominal wall injury can occur even after minor trauma without any associated intra-abdominal injury. We report a case of Spigelian hernia due to a handlebar injury in a male child of 9 years, who came for treatment 5 weeks after the injury. Ultrasonography confirmed the clinical diagnosis of traumatic Spigelian hernia. The case was taken up for open surgery and anatomical repair was done with prolene. The patient had an uneventful postoperative course.
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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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