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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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KC S, Gupta RK, Khanal B, Kumar A, Lamichhane S, Bhusal A, Sah VP, Bartaula S, Raki IH, Jindal R. Traumatic Abdominal wall hernia with ileal perforation following blunt trauma abdomen: A rare case report and review of literature. Radiol Case Rep 2024; 19:1819-1822. [PMID: 38420343 PMCID: PMC10899040 DOI: 10.1016/j.radcr.2024.01.081] [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] [Received: 01/08/2024] [Revised: 01/18/2024] [Accepted: 01/27/2024] [Indexed: 03/02/2024] Open
Abstract
Blunt trauma abdomen with abdominal wall herniation with bowel perforation is an acute emergency condition. Road traffic accidents causing blunt trauma are common in a youngster like in our case. Once the patient is resuscitated, ultrasonography and Computed tomography must be done. Early surgical exploration with mesh or primary repair of the defect is the mainstay of management. We have a case of a 25-year-old male with blunt trauma abdomen and anterior wall hernia following a road traffic accident who was managed with emergency exploratory laparotomy as computed tomography suggested anterior abdominal wall herniation of bowel content.
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Affiliation(s)
- Suraj KC
- Department of General Surgery, BPKIHS, Dharan, Nepal
| | | | | | | | | | - Amrit Bhusal
- Department of General Surgery, BPKIHS, Dharan, Nepal
| | | | | | | | - Raghav Jindal
- Department of General Surgery, BPKIHS, Dharan, Nepal
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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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Bejiga G. Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A 'case report'. Int J Surg Case Rep 2023; 105:107981. [PMID: 36948056 PMCID: PMC10040694 DOI: 10.1016/j.ijscr.2023.107981] [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: 12/02/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Bucket-handle mesenteric tear (BHMT) is a type of intestinal mesenteric injury where the intestine separates from its mesentery resulting in ischemia and perforation. Traumatic abdominal wall hernia (TAWH) is a disruption of the abdominal wall muscles and fascia in the presence of intact skin. BHMT and TAWH following bicycle handlebar injury in adults are rare. TAWH and generalized abdominal tenderness led to emergent surgical treatment in our patient. I aim to report these rare clinical entities in an adult patient with the management. This case report can create awareness among primary care physicians to decide on early referral and surgeons on early treatment. CASE PRESENTATION A 55y man presented 4 h after a bicycle handlebar injury to the abdomen. He had generalized abdominal pain but no history of vomiting, smoking, diabetes, or hypertension. Lab results were insignificant. TAWH and generalized tenderness led to the additional diagnosis of hollow-viscus perforation, but laparotomy revealed BHMT of the ileum and transverse colon. We did TAWH repair, bowel resection, and end-to-end anastomosis with excellent results. CLINICAL DISCUSSION BHMT following bicycle handlebar injury is rare in adults, with few case reports. Imaging is less sensitive, and surgery is the definitive diagnosis of BHMT.TAWH in adults after bicycle handlebar injury is rare and can be a sign of serious-intraabdominal injuries, and surgical repair is the treatment. CONCLUSION BHMT and TAWH following bicycle handlebar injury are rare in adults. BHMT can be life-threatening if not detected and treated early.
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Affiliation(s)
- Gosa Bejiga
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia.
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García Sánchez P, Bote Gascón P, González Bertolín I, Bueno Barriocanal M, López López R, de Ceano-Vivas la Calle M. Handlebar Hernia: An Uncommon Traumatic Abdominal Hernia. Pediatr Emerg Care 2021; 37:e879-e881. [PMID: 33105464 DOI: 10.1097/pec.0000000000002267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Handlebar hernia is a type of traumatic abdominal wall hernia caused by the impact of a bicycle handlebar against the abdominal wall. A good anamnesis and physical examination are important for the correct diagnosis, and ultrasonography is an accessible tool in the emergency department for imaging confirmation. We describe a case of an 11-year-old girl who presented to the emergency department after an abdominal trauma caused by a handlebar. Ultrasonography revealed an abdominal wall defect with herniation of omentum and bowel loops. Conservative management was initially established, followed by surgical treatment due to persistent symptoms.
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Affiliation(s)
- Paula García Sánchez
- From the Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain
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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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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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So HF, Nabi H. Handlebar hernia - A rare complication from blunt trauma. Int J Surg Case Rep 2018; 49:118-120. [PMID: 30005362 PMCID: PMC6037005 DOI: 10.1016/j.ijscr.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/12/2018] [Accepted: 06/10/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Handlebar hernias are rare; they result from blunt force impacting the abdomen. This focal blunt trauma causes a tear of the underlying abdominal muscle and fascia without necessarily disrupting the skin. The site of the hernia is usually remote from the site of trauma so clinicians may be falsely reassured if they locally explore the site of bruising. The physical examination of such patient may not obviously suggest such an injury and the diagnosis can be easily missed. CASE PRESENTATION A fit and well 10-year-old boy presented to the emergency department with left sided abdominal pain following a pushbike accident. He fell from his bicycle resulting in an impact of the handlebar to the left side of his abdomen. No obvious hernia was found on physical examination but there was a circular-shaped bruise in the left lower quadrant. An abdominal CT scan was then performed and the unusual diagnosis of a handlebar hernia was made. A prompt laparoscopic herniorrhaphy was performed and his post-operative recovery was uneventful. DISCUSSION A high level of suspicion is required to diagnose handlebar hernias. Even relatively low-speed trauma can result in this insidious injury. Laparoscopic repair has been demonstrated to be successful in this case. CONCLUSION Despite being a rare entity, handlebar hernias should be suspected when significant blunt force is applied to the abdominal wall from a handle bar injury. They may not be obvious on physical examination and therefore further imaging is often important. Management involves prompt surgical repair to prevent complications.
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Affiliation(s)
- Hang-Fai So
- University of Queensland, Department of Colorectal Surgery, Logan Hospital, Brisbane, Australia.
| | - Hajir Nabi
- Department of Colorectal surgery, Logan Hospital, Brisbane, Australia
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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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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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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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15
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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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Pederiva F, Guida E, Maschio M, Rigamonti W, Gregori M, Codrich D. Handlebar injury in children: The hidden danger. Surgery 2015; 159:1477. [PMID: 26387787 DOI: 10.1016/j.surg.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Federica Pederiva
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Edoardo Guida
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Massimo Maschio
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Waifro Rigamonti
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Massimo Gregori
- Department of Radiology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Daniela Codrich
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy.
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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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18
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Nishimura T, Nakao A, Okamoto A, Fujisaki N, Kotani J. A case of traumatic abdominal wall hernia with delayed bowel obstruction. Surg Case Rep 2015; 1:15. [PMID: 26943383 PMCID: PMC4747928 DOI: 10.1186/s40792-015-0023-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/23/2015] [Indexed: 11/26/2022] Open
Abstract
Background Traumatic abdominal hernia is rare and difficult to diagnose from physical symptoms. Patient A 60-year-old woman was admitted to the emergency department with complaints of vomiting after falling off a bicycle and hitting her abdomen against one of the handlebars 2 days earlier. Computed tomography (CT) demonstrated abdominal wall hernia from blunt trauma to the left upper abdomen. The patient underwent exploratory laparotomy, and the herniated bowel loop was not found to be perforated or gangrenous. Primary hernia repair without resection of the bowel loop was performed. Results Postoperative course was uneventful. Conclusion Surgical exploration with primary repair of the defect is the definitive treatment in the present case, as the hernia contained an incarcerated loop of small bowel. The use of abdominal CT to confirm the diagnosis before operative repair of the hernia appears to be a safe and efficacious adjunct to physical examination.
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Affiliation(s)
- Takeshi Nishimura
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Atsunori Nakao
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Ayana Okamoto
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Noritomo Fujisaki
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
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19
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Griffin LA, Scogletti VC, Nolan TC, Long EL, Nakayama DK, Sykes LN. Traumatic Abdominal Wall Hernia from a Handlebar Injury. Am Surg 2013. [DOI: 10.1177/000313481307900506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- L. Ashley Griffin
- Department of Surgery Mercer University School of Medicine Medical Center of Central Georgia Macon, Georgia
| | - Vincent C. Scogletti
- Department of Surgery Mercer University School of Medicine Medical Center of Central Georgia Macon, Georgia
| | - Tracy C. Nolan
- Department of Surgery Mercer University School of Medicine Medical Center of Central Georgia Macon, Georgia
| | - Eric L. Long
- Department of Surgery Mercer University School of Medicine Medical Center of Central Georgia Macon, Georgia
| | - Don K. Nakayama
- Department of Surgery Mercer University School of Medicine Medical Center of Central Georgia Macon, Georgia
| | - Leon N. Sykes
- Department of Surgery Mercer University School of Medicine Medical Center of Central Georgia Macon, Georgia
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20
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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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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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Moremen JR, Nakayama DK, Ashley DW, Astin M, Nolan TL. Traumatic disruption of the abdominal wall: lap-belt injuries in children. J Pediatr Surg 2013; 48:e21-4. [PMID: 23583160 DOI: 10.1016/j.jpedsurg.2013.02.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/07/2013] [Accepted: 02/03/2013] [Indexed: 10/27/2022]
Abstract
Traumatic abdominal wall hernia (TAWH) from high speed mechanism is a unique finding in adult trauma, and exceedingly rare in pediatrics. The majority of reports are of low-speed "handlebar" hernias associated with direct injury by bicycle handlebars. We report a series of three pediatric patients in motor vehicle collisions (MVC) who experienced TAWH by lap-belt and associated intra-abdominal injuries necessitating immediate operative intervention. Different operative approaches were used in each case to manage the varying types of disruptions. This adds to the pediatric literature the largest series of its kind.
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Affiliation(s)
- Jacob R Moremen
- Mercer University School of Medicine and Medical Center of Central Georgia, Departments of Surgery, Trauma and Surgical Critical Care, and Emergency Medicine, Macon, GA, USA.
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23
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Davey SR, Smart NJ, Wood JJ, Longman RJ. Massive traumatic abdominal hernia repair with biologic mesh. J Surg Case Rep 2012; 2012:rjs023. [PMID: 24968420 PMCID: PMC3854980 DOI: 10.1093/jscr/rjs023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Traumatic abdominal wall hernias (TAWHs) are rare. They can arise from either high or low impact trauma and can be associated with significant associated injury. We present the case of a 27-year-old male involved in a high-impact road traffic accident resulting in a TAWH. He sustained significant disruption to the abdominal wall and sustained injuries to the thoracic cage. Operative management was undertaken with a porcine dermal collagen mesh, using a bridge technique.
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Affiliation(s)
- Simon R Davey
- Department of Coloproctology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Neil J Smart
- Department of Coloproctology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - James J Wood
- Department of Coloproctology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Robert J Longman
- Department of Coloproctology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
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24
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Iqbal CW, St Peter SD, Hendrickson RJ. Repair of a traumatic lateral abdominal wall hernia in an 11-year-old boy, using a minimally invasive approach. TRAUMA-ENGLAND 2012. [DOI: 10.1177/1460408612440926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the case of an 11-year-old boy who sustained blunt abdominal trauma while bicycling. An abdominal computed tomography scan obtained during his trauma evaluation was suspicious of a right-sided abdominal wall hernia with acute inflammatory changes although there was no palpable mass on physical examination. In follow-up, he was found to have a palpable mass in his right lateral abdominal wall, which enlarged with valsalva. The hernia was repaired primarily using a minimally invasive approach with a 5-mm umbilical cannula and a stab incision over the defect. He was discharged home on the first post-operative day. At 1 year follow-up, he is symptom-free without evidence of recurrence. Lateral abdominal wall hernias in the pediatric patient are uncommon but can result from trauma. Primary repair using a minimally invasive approach is safe and effective in achieving adequate closure.
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Affiliation(s)
- Corey W Iqbal
- Children’s Mercy Hospital and Clinics, Kansas City, MO, USA
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25
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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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26
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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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27
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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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28
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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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29
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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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30
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Rowell EE, Chin AC. Laparoscopic repair of traumatic abdominal wall hernia from handlebar injury. J Pediatr Surg 2011; 46:e9-e12. [PMID: 21616228 DOI: 10.1016/j.jpedsurg.2011.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 01/21/2011] [Accepted: 01/28/2011] [Indexed: 10/18/2022]
Abstract
A 14-year-old boy was seen at an outside hospital after falling over the handlebar of his bicycle and was discharged home. He was subsequently seen in our emergency department with complaints of persistent abdominal pain. A computed tomography scan of the abdomen revealed disruption of the muscles of the upper right abdominal wall containing the hepatic flexure of the colon, with a small amount of intraperitoneal free fluid noted. The patient underwent laparoscopic exploration using 3 ports (2-5 mm and 1-12 mm) and 2 separate stab incisions. The traumatic abdominal wall hernia was repaired with interrupted sutures placed with an ENDO CLOSE (Covidien, Mansfield, MA) device, and a mesenteric defect in the colon was approximated with intracorporeal sutures. The trocar sites were sutured closed. The patient recovered well and was discharged home. Follow-up examination revealed no abdominal wall defect and resolution of his symptoms. Laparoscopic repair of a traumatic abdominal wall defect and exploratory laparoscopy after trauma is feasible and safe in the pediatric patient. It should be considered as an alternative approach with potentially less morbidity than an exploratory laparotomy for handlebar injuries in a stable patient.
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Affiliation(s)
- Erin E Rowell
- Division of Pediatric Surgery, Children's Memorial Hospital, Northwestern Feinberg School of Medicine, Chicago, IL 60614, USA.
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31
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van Bemmel AJM, van Marle AGJ, Schlejen PM, Schmitz RF. Handlebar hernia: a case report and literature review on traumatic abdominal wall hernia in children. Hernia 2010; 15:439-42. [PMID: 20437188 PMCID: PMC3145084 DOI: 10.1007/s10029-010-0665-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 04/09/2010] [Indexed: 11/03/2022]
Abstract
A rare case of abdominal trauma, a handlebar hernia, is described, as well as a review of the pertinent literature. A 7-year-old boy presented to our emergency room after sustaining blunt force to the abdomen; he fell on the handlebar of his bicycle. Immediately after the accident, a bulge was noticeable at the point of impact. Handlebar hernia is a diagnosis that is easily missed, which can lead to strangulation and incarceration of the bowel. With this case report, we hope to augment the knowledge on traumatic abdominal wall hernia, hopefully leading to early diagnosis and treatment.
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Affiliation(s)
- A J M van Bemmel
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.
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