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Lu H, Zhang Z, Chao J, Zhang C, Zhang G, Tao S, Yan Q. Case Report: Minimally invasive repair of a traumatic abdominal wall hernia in a child with a fascial closure device. Front Surg 2024; 11:1391533. [PMID: 39035114 PMCID: PMC11257973 DOI: 10.3389/fsurg.2024.1391533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/30/2024] [Indexed: 07/23/2024] Open
Abstract
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.
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Affiliation(s)
- Huiyu Lu
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Zemin Zhang
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, China
| | - Jun Chao
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Chuanguang Zhang
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, China
| | - Guoqing Zhang
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, China
| | - Shujie Tao
- Department of Dermatology, Weifang People's Hospital, Weifang, China
| | - Qingtao Yan
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang, China
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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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Leiva T, Golubkova A, Snyder K, Johnson J, Hunter CJ. Pediatric Traumatic Lumbar Hernias and Associated Injuries: A Case Series. Pediatr Emerg Care 2024; 40:103-107. [PMID: 38295192 DOI: 10.1097/pec.0000000000003116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Traumatic lumbar hernias are a rare entity mostly seen with high-impact, blunt abdominal trauma. This injury occurs when there is disruption of the posterior musculature along with bony structures, allowing for herniation of abdominal contents. There are minimal cases of this entity reported in adults, but even fewer in the pediatric population. METHODS We describe 3 cases of traumatic lumbar hernia at our institution as well as provide a review of the literature to elucidate the most common mechanisms, severity of injury, and associated injuries. RESULTS Traumatic lumbar hernia is most commonly seen in restrained passengers involved in motor vehicle collisions. A majority of cases are diagnosed using computed tomography imaging and less frequently during primary surgical exploration. The most common associated injuries were mesenteric and bowel injuries, followed by spinal and chest trauma. Traumatic lumbar hernia often leads to prolonged hospital stays and increased need for posthospital rehabilitation because of associated traumatic comorbidities. CONCLUSIONS Traumatic lumbar hernia is a rare entity in children, and early suspicion and identification of associated injuries is necessary in the management of these patients.
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Affiliation(s)
- Tyler Leiva
- From the Division of Pediatric Surgery, Oklahoma Children's Hospital, Oklahoma City, OK
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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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Hernandez Cervantes BY, Martínez Lopez D, Guzman Lambert R, Rodríguez Gonzalez M, Meah M. Acute traumatic abdominal wall hernia-value of the physical examination: case report. J Surg Case Rep 2021; 2021:rjab314. [PMID: 34316351 PMCID: PMC8301642 DOI: 10.1093/jscr/rjab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/26/2021] [Indexed: 12/22/2022] Open
Abstract
Acute traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after a low or high velocity impact of the abdominal wall against a blunt object with few cases reported. Perforations of the hollow viscera commonly follow abdominal trauma and likely require surgery for hemorrhage and sepsis source control. We report a case where a high velocity impact of the abdominal wall against the stump of a felled tree caused a TAWH with concomitant gastric perforation in a 20-year-old male patient who required exploratory laparotomy with primary repair of the stomach and fascia. The physical examination findings without previous history of abdominal hernia and pneumoperitoneum in the chest X-ray made suspect our diagnosis and it was confirmed intraoperatively. At 3 months postoperatively the patient has a strong abdominal wall. It is imperative to emphasize the importance of the physical examination goal of not losing diagnosis of TAWH.
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Affiliation(s)
| | - Duniesky Martínez Lopez
- Department of Internal Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Radisnay Guzman Lambert
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Mariuska Rodríguez Gonzalez
- Department of Internal Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Mary Meah
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Sorber R, Pedroso FE, Cappiello CD, Kunisaki SM, Jelin EB, Rhee DS. Pediatric traumatic abdominal wall hernia as a component of the seatbelt syndrome: a case series and review of the literature. Pediatr Surg Int 2021; 37:511-517. [PMID: 33385244 DOI: 10.1007/s00383-020-04796-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Blunt impact-induced traumatic abdominal wall hernia (TAWH) is an uncommon pediatric surgical problem classically associated with handlebar injury but increasingly seen with seatbelt use in motor vehicle collisions (MVC). Herein we describe the largest case series of pediatric TAWH to date and review the literature to establish the unique syndromic characteristics of MVC-associated TAWH. METHODS In this single-institution series, we discuss four pediatric patients, all with seatbelt-associated TAWH after high-speed MVC characterized by full-thickness disruption of the lateral abdominal wall. We then performed a review of the literature to identify additional pediatric MVC-associated TAWH and define the characteristics of patients who sustained this unique injury. RESULTS In addition to the four patients in our case series, five additional pediatric patients presenting with TAWH after restrained MVC were identified in the literature. Of these nine patients, eight (89%) presented with an obvious seatbelt sign (bruising/laceration to the abdominal wall). Six (67%) had associated injuries typical of the seatbelt syndrome, including four spinal flexion injuries (44%) and five bowel injuries requiring repair or resection (56%). Overall, 56% of seatbelt-associated TAWH occurred in children with a BMI percentile > 95%. CONCLUSIONS In this case series and literature review, we note a high rate of seatbelt syndrome injuries in pediatric patients presenting with TAWH after restrained MVC. Suspicion for TAWH should be high in children presenting with a seatbelt sign and should trigger a low threshold for pursuing additional axial imaging. LEVEL OF EVIDENCE Level IV; case series.
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Affiliation(s)
- Rebecca Sorber
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA.
| | - Felipe E Pedroso
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Clint D Cappiello
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Shaun M Kunisaki
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Eric B Jelin
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Daniel S Rhee
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, 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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Lamoshi A, Wagner N, Chen Z, Fabiano T, Wilding GE, Rothstein DH, Bass K. Predictive Model for Operative Intervention after Blunt Abdominal Trauma in Children with Equivocal CT Findings: A Pilot Study. J Surg Res 2020; 255:449-455. [PMID: 32619860 DOI: 10.1016/j.jss.2020.05.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To study the clinical and radiologic factors predicting the need for surgical intervention after blunt abdominal trauma (BAT) in children with equivocal computed tomography (CT) scan findings. METHODS We performed a retrospective review of the trauma database at our level I pediatric trauma center between 2011 and 2019. We selected patients with BAT and equivocal findings for surgical intervention on CT scan. We studied five factors: abdominal wall bruising (AWB), abdominal pain/tenderness (APT), thoracolumbar fracture, the presence of free fluid (FF), and the presence of solid organ injury, all previously reported in the literature to predict the need for operative intervention. We used t-test, the Kruskal-Wallis test and logistic regression to study the association of these factors with the need for operation in our pediatric cohort. RESULTS Of 3044 blunt trauma patients, 288 had abdominal CT scans with 61 patients demonstrating equivocal findings. Operation was performed for 12 patients (19.7%) confirming surgically correctable traumatic injuries. The need for surgical intervention was significantly associated with the age of the patients (P = 0.03), the presence of APT (P = 0.001), AWB (P = 0.01), and FF (P = 0.04). The presence of thoracolumbar fracture and solid organ injury were not significantly associated with the need for operation. For the subset of 37 patients who were injured in a motor vehicle crash, five (13.5%) required surgical intervention, which was significantly associated with the presence of AWB (P = 0.04), APT (P = 0.01), and FF (P = 0.03). A predictive model that used these factors produced a receiver operating characteristic curve of 0.86. CONCLUSIONS In cases of equivocal abdominal CT scan findings to evaluate BAT in children, the presence of abdominal wall tenderness, AWB, or FF may be significant factors predicting more accurately the need for operative intervention. A predictive model using the combination of clinical and image findings might determine with more certainty, the need for surgical intervention in children with BAT and equivocal CT findings. Validation on a larger multi-institutional data set should be done.
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Affiliation(s)
- Abdulraouf Lamoshi
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York.
| | - Nicole Wagner
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York
| | - Ziqiang Chen
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Tiffany Fabiano
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Kathyrn Bass
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
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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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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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