traumatic abdominal wall hernia

Traumatic abdominal wall hernia describes the traumatic disruption of musculature and fascia of anterior abdominal wall without skin penetration.

Clinical presentation

Abdominal skin ecchymosis or abrasions may be seen.

Pathology

Traumatic abdominal wall hernia is caused by blunt trauma to the abdomen. In adults, it usually results from road traffic accidents, while in children it occurs following an injury from the bicycle handlebar.

In these injuries, a sudden increase in intraabdominal pressure due to the direct impact results in abdominal wall disruption that is insufficient to penetrate the skin but strong enough to disrupt muscle and fascia.

There is often no evidence of a prior hernia defect at the site of injury.

Associations

Bowel, mesenteric, pancreatic and other visceral injuries are very common.

Radiographic features

Disruption of all layers of muscle and fascia yet elastic skin layer remains intact.

Although the size of the tear may vary significantly, some classically described locations include:

  • region of the iliac crest in seat belt injury (site of lap and shoulder strap junction)
  • focal, lower abdomen, lateral to the rectus sheath, inguinal region
  • larger diffuse abdominal wall defects sustained in motor car accidents
  • rarely in the retroperitoneum

Treatment and prognosis

Surgical repair with mesh or without mesh is necessary .

Differential diagnosis

Other types of abdominal wall hernia.