Laparoscopic repair of traumatic abdominal wall hernia from handlebar injury

Case Report: Minimally invasive repair of a traumatic abdominal wall hernia in a child with a fascial closure device

Abdominal trauma is common in daily life, but a traumatic abdominal wall hernia (TAWH) in children is rare. A TAWH is caused by a huge external force that leads to subcutaneous muscle and fascia rupture, while the skin remains intact. As abdominal pressure increases, the abdominal contents protrude, forming a lump. A TAWH is highly susceptible to missed diagnosis because of other severe injuries. We report a case of a 2-year-old boy with a TAWH who developed a prominent subcutaneous mass on the right side of his abdomen after abdominal trauma; the size of the mass changed significantly with abdominal pressure and crying. In this case, we used a new approach of laparoscopic suture repair technique with the assistance of a fascial closure device and achieved good results. We found that this method offers the advantages of minimally invasive surgery, fast recovery, and no visible surgical incisions. There was no recurrence after 8 months of follow-up.

Post-traumatic lateral abdominal wall hernia: a case report

Traumatic abdominal wall hernia (TAWH) also known as blunt abdominal TAWH is uncommon. The clinical diagnosis is difficult. The authors present a case report of posthigh-energy abdominal blunt trauma causing a TAWH.

Case presentation

A 36-year-women, with unremarkable past medical history, was presented to the Emergency Department after a stuck in high-speed two automobiles. She was hemodynamic, respiratory, and neurologically stable. The BMI was 36 kg/m². The abdomen was not distended with an ecchymotic lesion on the right flank. The thoracic abdominal and pelvic computed tomography (CT) scan revealed a rupture in the lateral abdominal wall muscles with a TAWH in the location of the skin ecchymoses. There was no visceral lesion or intraperitoneal fluid. A conservative treatment was indicated. The follow-up was uneventful, with hematoma resorption and no cellulitis or abscess. The patient was discharged after 1 week. An abdominal repair will be planned using a mesh.

Clinical discussion

TAWH is a rare entity. The best imaging modality for diagnosis is the CT scan allowing classification of the hernia and a screen for other injuries. The presence of an isolated TAWH must lower the threshold to closely monitor or to operatively explore, given the high rate of false-negative findings at imaging features.

Conclusion

TAWH should be suspected behind any blunt abdominal trauma with high energy. CT scan and ultrasound were helpful for diagnosis and the only curative treatment is surgery to avoid complications.

Traumatic Abdominal Wall Hernia in Children: A Systematic Review

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.

Traumatic Abdominal Wall Hernia in Children by Handlebar Injury: When to Suspect, Scan, and Call the Surgeon

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.

Simplified Repair of Traumatic Iliac Crest Flank Hernias with Mesh Strips

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.

["Handlebar" hernia: a rare type of traumatic parietal hernia]

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.

What we know about management of traumatic abdominal wall hernia: review of the literature and case report

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.

Laparoscopic-assisted management of traumatic abdominal wall hernias in children: case series and a review of the literature

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.

Paediatric abdominal wall hernia following handlebar injury: should we diagnose more and operate less?

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.

Repair of a traumatic lateral abdominal wall hernia in an 11-year-old boy, using a minimally invasive approach

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.

Traumatic abdominal wall hernias: an emerging trend in handlebar injuries

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.