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. 2014;5(12):1238-41.
doi: 10.1016/j.ijscr.2014.11.036. Epub 2014 Nov 15.

Abdominal wall hernia and aortic injury secondary to blunt trauma: Case report and review of the literature

David H Ballard  1 , Nadine M Kaskas  1 , Alireza Hamidian Jahromi  2 , Justin Skweres  3 , Asser M Youssef  4
Affiliations

Abdominal wall hernia and aortic injury secondary to blunt trauma: Case report and review of the literature

David H Ballard et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Traumatic abdominal wall hernia (TAWH) and traumatic abdominal aortic injury (TAAI) are two uncommon complications secondary to blunt trauma. In both TAWH and TAAI, reported cases are often associated with poly-trauma. TAWH may be initially missed if more pressing issues are identified during the patient's primary survey. TAAI may be an incidental finding on imaging or, if severe, a cause of an acute abdomen and hemodynamic abnormality.

Presentation of case: A 54-year-old white male suffered a TAWH and TAAI (pseudoaneurysm) due to severe blunt trauma. TAWH was apparent on physical exam and the TAAI was suspected on computed tomography (CT). The patient's TAWH was managed with a series of abdominal explorations and the TAAI was repaired with endovascular stenting.

Discussion: TAWH and TAAI are commonly due to severe blunt trauma from motor vehicle collisions. Diagnosis is made through physical exam, imaging studies, or surgical exploration. A variety of surgical techniques achieve technical success.

Conclusion: The patient with blunt trauma to the abdomen is at risk for TAWH and TAAI, which are often associated with other injuries. Investigations should include thorough clinical exam through secondary survey and radiologic imaging in the hemodynamically normal patient.

Keywords: Abdominal aortic pseudoaneurysm; Blunt abdominal aortic injury; Blunt abdominal trauma; General surgery; Trauma surgery; Traumatic abdominal wall hernia.

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Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography scan shows traumatic ventral herniation of small bowel, cecum, and mesentery through the anterolateral abdominal wall. The cecum is partially included in the hernia sac, while the terminal ileum (solid arrow) and appendix (dashed arrow) remain intra-abdominal (E, external oblique; I, internal oblique; T, transversus abdominis).
Fig. 2
Fig. 2
(A) Computed tomography angiogram (CTA) shows the bowel herniation and the abdominal aortic pseudoaneurysm (arrowhead). (B) 3D volume rendering of this CTA reveals the post-operative open abdomen (S, skin; E, external oblique; R, rectus abdominis; H, hernia sac).
See this image and copyright information in PMC

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