Journal of Trauma and Injury

Massive traumatic abdominal wall hernia in pediatric multitrauma in Australia: a case report: Sarah Douglas-Seidl, Camille Wu; J Trauma Inj. 2023;36(4):447-450. Published online November 7, 2023; DOI: https://doi.org/10.20408/jti.2023.0023

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Abstract PDF: Traumatic abdominal wall hernia is a rare presentation, most commonly reported in the context of motor vehicle accidents and associated with blunt abdominal injuries and handlebar injuries in the pediatric population. A 13-year-old boy presented with multiple traumatic injuries and hemodynamic instability after a high-speed motor vehicle accident. His injuries consisted of massive traumatic abdominal wall hernia (grade 4) with bowel injury and perforation, blunt aortic injury, a Chance fracture, hemopneumothorax, and a humeral shaft fracture. Initial surgical management included partial resection of the terminal ileum, sigmoid colon, and descending colon. Laparostomy was managed with negative pressure wound therapy. The patient underwent skin-only primary closure of the abdominal wall and required multiple returns to theatre for debridement, dressing changes, and repair of other injuries. Various surgical management options for abdominal wall closure were considered. In total, he underwent 36 procedures. The multiple injuries had competing management aims, which required close collaboration between specialist clinicians to form an individualized management plan. The severity and complexity of this injury was of a scale not previously experienced by many clinicians and benefited from intrahospital and interhospital specialist collaboration. The ideal aim of primary surgical repair was not possible in this case of a giant abdominal wall defect.; Summary

Repair of traumatic flank hernia with mesh strip suture: a case report: Shin Ae Lee, Ye Rim Chang; J Trauma Inj. 2022;35(Suppl 1):S46-S52. Published online August 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0026

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Abstract PDF: Traumatic flank hernia is a relatively rare hernia. We report a case of a male patient with severe multiple trauma, including abdominal injury, who presented with flank hernia 3 years postinjury. The hernia was successfully repaired using mesh strips suture, and at the 12-month follow-up, no complications or recurrence was found. Our findings indicate that when it is difficult to secure a sufficient operative field for mesh anchoring in a traumatic flank hernia, a technique of sutured repair with mesh strips may be considered as a treatment option as it requires less dissection. Compared to the conventional planar mesh repair, this technique decreases the risk of injuries and ischemic necrosis of the surrounding tissues.; Summary

Incidental traumatic right diaphragmatic rupture: a missed case after trauma: Fatima Alharmoodi, Shadin Ghabra, Salem Alharthi; J Trauma Inj. 2023;36(1):56-59. Published online June 23, 2022; DOI: https://doi.org/10.20408/jti.2022.0008

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Abstract PDF: Traumatic diaphragmatic hernia is among the most uncommon conditions after severe trauma, and it is associated with high morbidity and mortality. The diagnosis is difficult and might be missed, but a multimodal investigation might help in terms of diagnostic yield. In this case report, we present a missed right diaphragmatic rupture 14 years after the trauma.; Summary

Traumatic abdominal wall hernia with hemoperitoneum caused by blunt injury: laparoscopic exploration with mini-laparotomy repair. A case report: Euisung Jeong, Hyunseok Jang, Younggoun Jo, Yunchul Park, Naa Lee, Jungchul Kim; J Trauma Inj. 2022;35(1):61-65. Published online December 23, 2021; DOI: https://doi.org/10.20408/jti.2021.0062

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Abstract PDF

Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient’s symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.

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Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature
Arwa M Aljuhani, Ghaith A Al Saied, Arjmand Reyaz, Mohammed A Alkahlan, Ibrahim M Aljohani, Muhammed M Abukhater
International Journal of Abdominal Wall and Hernia.2024;[Epub] CrossRef

Dual repair of traumatic flank hernia using laparoscopic and open approaches: a case report: Yoonjung Heo, Dong Hun Kim; J Trauma Inj. 2022;35(1):46-50. Published online October 25, 2021; DOI: https://doi.org/10.20408/jti.2021.0008

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Abstract PDF Supplementary Material: Traumatic flank hernia (TFH) is rare and prone to recurrence, which makes appropriate treatment challenging. No current guidelines define the optimal timing and method of repair. Meanwhile, recent advances in laparoscopic techniques are reshaping the options for the treatment of TFH. A dual approach that utilizes both laparoscopic and open methods has not previously been reported. Herein, we present the successful treatment of TFH after blunt trauma. A 46-year-old male patient underwent elective herniorrhaphy on hospital day 3, in which laparoscopic implantation of a sublay mesh and extracorporeal implantation of an onlay mesh were performed. Such techniques may be appropriate and result in feasible outcomes in hemodynamically stable patients with large TFH who are strongly suspected of having bowel herniation or concomitant intraperitoneal injuries. Larger studies are needed to assess the long-term results.; Summary

Small Bowel Hernia due to a Blunt Pelvic Injury: Min Jae Gal, Jung Chul Kim; J Trauma Inj. 2021;34(3):187-190. Published online September 30, 2021; DOI: https://doi.org/10.20408/jti.2020.0022

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Abstract PDF: A 91-year-old female presented to Chonnam National University Hospital Regional Trauma Center with a lateral compression type III fracture of the pelvis. She was managed non-operatively for a week in the intensive care unit under close observation and had an emergency operation due to delayed onset of an acute obstructed direct inguinal hernia. Traumatic abdominal wall hernias are rare. However, trauma surgeons should always be aware of the possibility of such injuries because of their critical consequences.; Summary

Blunt Transection of the Entire Anterolateral Abdominal Wall Musculature Following Seatbelt-Related Injury: Hohyun Kim, Jae Hun Kim, Gil Hwan Kim, Hyun-Woo Sun, Chan Ik Park, Sung Jin Park, Chan Kyu Lee, Suk Kim; J Trauma Inj. 2020;33(2):128-133. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0006

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Abstract PDF: Traumatic abdominal wall hernias (TAWHs) are uncommon and the incidence of this, which is rarely encountered in clinical practice, has been estimated at 1%. Furthermore, blunt transection of the entire abdominal wall musculature caused by seatbelt is a very rare complication. We report a case of adult with a complete disruption of the entire anterolateral abdominal wall muscle following the seatbelt injury. A 32-year-old male was wearing a seat belt in a high speed motor vehicle collision. Abdominal computed tomography (CT) scan revealed the complete disruption of bilateral abdominal wall musculatures including TAWH without visceral injury. However, injuries of small bowel and sigmoid colon were observed in the intra-operative field. The patient underwent the repair by primary closure of the defect with absorbable monofilament sutures. This case suggests that especially in TAWH patients, even if a CT scan is normal, clinicians should keep the possibility of bowel injury in mind, and choose a treatment based on the clinical findings.; Summary

Comparison of Penetrating and Blunt Traumatic Diaphragmatic Injuries: Sang Su Lee, Sung Youl Hyun, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jae Hyug Woo; J Trauma Inj. 2019;32(4):210-219. Published online December 30, 2019; DOI: https://doi.org/10.20408/jti.2019.034

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Abstract PDF

Purpose

Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury.

Methods

We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury.

Results

In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity.

Conclusions

Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients’ prognosis. Multi-center, prospective studies are needed in the future.

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An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa
CM Kithuka, VC Ntola, W Sibanda
South African Journal of Surgery.2023; 61(3): 12. CrossRef
Factors Associated with Successful Video-Assisted Thoracoscopic Surgery and Thoracotomy in the Management of Traumatic Hemothorax
Heather M. Grant, Alexander Knee, Michael V. Tirabassi
Journal of Surgical Research.2022; 269: 83. CrossRef

Acute Pancreatitis after Additional Trauma in Chronic Traumatic Pancreatic Diaphragmatic Hernia: You Ho Mun, Sin Youl Park; J Trauma Inj. 2019;32(1):66-70. Published online March 31, 2019; DOI: https://doi.org/10.20408/jti.2019.007

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Abstract PDF: Traumatic diaphragmatic injuries (TDIs) are a rare complication in thoraco-abdominal trauma. The diagnosis is difficult and if left untreated, TDI can cause traumatic diaphragmatic hernia (TDH). Through an injured diaphragm, the liver, spleen, stomach, small intestine, and large intestine can be herniated to the thoracic cavity, but pancreatic herniation and pancreatitis are quite rare in TDH. This paper reports a case of pancreatitis developed by additional trauma in a patient with asymptomatic chronic TDH. A 58-year-old male visited the emergency department with a left abdominal injury after a fall 6 hours earlier. The vital signs were stable, but the amylase and lipase levels were elevated to 558 U/L and 1,664 U/L, respectively. Abdominal computed tomography (CT) revealed a left diaphragmatic hernia and an incarceration of the stomach, pancreatic ductal dilatation, and peripancreatic fatty infiltration. Additional history taking showed that he had suffered a fall approximately 20 years ago and had an accidentally diaphragmatic hernia through a chest CT 6 months earlier. A comparison with the previous CT revealed the pancreatitis to be caused by secondary pancreatic ductal obstruction due to the incarcerated stomach. For pancreatitis, gastrointestinal decompression was performed, and after 3 days, the pancreatic enzyme was normalized; hence, a thoracotomy was performed. A small ruptured diaphragm was found and reposition of the organs was performed. This paper reports the experience of successfully treating pancreatitis and pancreatic hernia developed after trauma without complications through a thoracotomy following gastrointestinal decompression.; Summary

Traumatic Abdominal Wall Hernia: A Case Report: Youngro Yang, Kwangsig Kim; J Trauma Inj. 2017;30(2):70-73. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.70

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Abstract PDF

Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma to the abdomen. Generally there has been an increase in the incidence of blunt abdominal trauma, although the case of traumatic abdominal wall hernias are rare. Probably due to the elasticity of the abdominal wall for resisting the shear forces generated by a traumatic impacts. In this case, we are reporting 1 rare case, diagnosed as an abdominal wall hernia associated with herniation of bowel loops due to blunt trauma without intra-abdominal injury including peritoneum.

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Traumatic abdominal wall hernia: a rare and often missed diagnosis in blunt trauma
Sohil Pothiawala, Sunder Balasubramaniam, Mujeeb Taib, Savitha Bhagvan
World Journal of Emergency Medicine.2022; 13(6): 492. CrossRef

Closed Digital Reduction of Posttraumatic Lung Hernia: Ki Sung Park; J Korean Soc Traumatol. 2012;25(3):91-93.

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Abstract PDF: Postraumatic lung hernia is a rare occurrence. A number of cases reported in the literature have been treated with early thoracotomy to repair partial protruded lung and pleura to prevent strangulation and incarceration. We present a case of a 45-year-old patient of left posttrumatic lung hernia, in which closed digital reduction was successful. The strategy of the management approach could be established by further accumulated experience.; Summary

A Case of Traumatic Ventral Hernia Repair with a Porcine Dermal Collagen Graft (Permacol): Byung Chul Yu, Min Chung; J Korean Soc Traumatol. 2012;25(2):63-66.

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Abstract PDF: Resection of the bowel is necessary for the repair of a ventral hernia after recovery from trauma in some cases. In such instances, polyester or polypropylene meshcannot be used due to the possibility of infection; we had to use biological mesh instead. We report a case in which a traumatic hernia was repaired with Permacol (Covidien, Norwalk, CT, USA). A 42-year-old male patient had been injured by a factory machine seven months prior to admission. At that time, he had abdominal wall injury and small bowel perforation. His abdominal wall had been a defect after operation. A CT scan of the abdomen showed that the left abdominal wall, which is lateral to left rectus abdominis muscle had only one muscle layer, an external oblique muscle, and that a previous abdominal incision had a defect along the entire incision. During the exploration, 10 cm of small bowel was removed due to firm adhesion to the previous surgical scar. Permacol mesh was applied and fixed with transfascial fixations and tacks by using the intraperitoneal onlay mesh technique. There were no complications after the surgery and the patient was discharged without any problems.; Summary

Traumatic Abdominal Wall Hernia (TAWH): Repair by using a Prolen Mesh: Seung Yeon Park, Min Chung; J Korean Soc Traumatol. 2009;22(1):119-122.

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Abstract PDF: Traumatic abdominal wall hernia after blunt abdominal trauma is rare. The prevalence of traumatic abdominal wall hernia in published series is approximately 1%. Recently, by the use of computed tomography has increased the number of occult traumatic abdominal wall hernias (TAWH). A 47-year-old woman presented to the emergency room soon after a traffic accident. She was fully conscious and complained of diffuse, dull, abdominal pain. She had a seat belt on at the time of the accident. Initial computed tomography showed that the lower left abdominal wall had a defect and that a part of the small bowel had herniated through the defect. During the operation, we made an incision at the defect site and confirmed the defect. The defect size was about 15x5 cm. The muscle layers were repaired in layers with absorbable sutures. Prolen mesh was layed down and fixed on the site of the repaired muscle defect. After 6 months, hernia had not recurred, and no weakness of the repaired abdominal wall layers was identified. The patient`s postoperative body functions were normal.; Summary

Traumatic Lumbar Hernia: Report of a Case: Gil Jae Lee, Min Chung, Byung Chul Yu; J Trauma Inj. 2013;26(3):222-225.

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Abstract PDF: The occurrence of traumatic hernia is rare. However, traumatic lumbar hernias are the most frequently occurring traumatic hernias. Superior lumbar hernias occur more frequently than inferior lumbar hernias, but for anatomical reasons, among traumatic lumbar hernias, inferior lumbar hernias occur more frequently than superior lumbar hernias. Repair of a lumbar hernia is very difficult. Mesh fixation to the bony part and general weakness of surrounding tissue make repair of a lumbar hernia tricky. A traumatic lumbar hernia was repaired using transfascial fixation around the defect to secure the mesh. This technique is another choice for a lumbar hernia technique.; Summary

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