Traumatic abdominal wall hernia after impact from handlebar: A case report

Abstract

Traumatic abdominal wall hernia (TAWH) is a rare type of hernia resulting from blunt abdominal trauma. It develops following the inertia of sudden, high-energy blunt trauma or focused low-energy impact. A 22-year-old motorcyclist presented to the emergency department following a collision with an automobile. Clinical examination demonstrated a bulging mass at the lower abdomen, resulting from impact with the motorcycle handlebar. A contrast-enhanced CT scan of the abdomen revealed a disruption of both rectus abdominis muscle and linea alba at the lower abdomen with loops of small bowels and mesentery herniating through the defect, associated with multiple air pockets and pneumoperitoneum. Exploratory laparotomy showed TAWH containing loops of small bowel and mesentery in addition to mesenteric tears. Small bowel resection with primary anastomosis and repair of the anterior abdominal wall defect using interrupted polypropylene sutures was performed. The patient recovered well postoperatively and was discharged home three days later. A follow-up at 1 year showed no evidence of recurrence.

Keywords: Abdominal wall hernia; Accidental injuries; Herniorrhaphy; Trauma.

Fig. 1

Lower abdominal wall swelling associated with overlying skin contusion, visualized from the anterior (A) and lateral view (B).

Fig. 2

Axial view of the abdominal CT scan demonstrating a defect in the linea alba resulting in herniation of small bowel and it's mesentery, with the presence of air pockets (arrow).

Fig. 3

(A) Small bowel herniation with perforation (arrow) upon exploration. (B) Linea alba and rectus sheath defect after reduction of small bowel. (C) Small bowel mesentery tears. (D) Upper two thirds of the laparotomy wound closed en-masse with continuous polypropylene sutures and the ventral hernia defect at the lower one third was closed with interrupted vertical mattress polypropylene sutures.