Immediate Exploration of The Traumatic Abdominal Wall Disruption in Children: A Case Report

Authors

  • Thanapon Supapon Department of Surgery, Phrapokklao Hospital, Chanthaburi
  • Chusak Wangruttanasopon Department of Surgery, Phrapokklao Hospital, Chanthaburi

Keywords:

Traumatic abdominal wall injury, Abdominal wall hernia, Pediatric

Abstract

Background: Traumatic abdominal wall disruption in children is a rare but severe diagnosis resulting from blunt abdominal trauma (BAT). The clinical diagnosis is not usually straightforward, and the hernia is often discovered at the time of the surgical exploration for intra-abdominal injuries or by imaging studies.

Presentation of Case: A 13-year-old boy, a restrained male patient, was the victim of a high-speed road traffic accident. Among other injuries, he showed bruising over the lower abdomen and localized right-side peritonitis upon presentation. A contrast-enhanced computed tomography scan of the chest and abdomen demonstrated abdominal wall muscular disruption over the right lower quadrant with herniation of the large bowel. The patients had immediate exploratory laparotomy with hernia repair.

Discussion: Traumatic abdominal wall disruption is a rare form of hernia caused by abdominal wall musculature and fascia disruption. The diagnostic criteria and classification of traumatic abdominal wall disruption are still unclear; furthermore, the ideal timing and method of surgical treatment are still unclear. Herein, we report a case of traumatic abdominal wall disruption and describe the surgical approach used.

Conclusion: Children with traumatic abdominal wall disruption have high rates of concomitant abdominal organ injury requiring operative repair. CT scans have low sensitivity and specificity for detecting associated injuries. A high suspicion of injury and low threshold for exploration must be maintained in traumatic abdominal wall disruption cases.

References

Selby CD. Direct abdominal hernia of traumatic organ. JAMA 1906;47(18):1485-86. doi: 10.1001/jama.1906.25210180061002c.

Dennis RW, Marshall A, Deshmukh H, et al. Abdominal wall injuries occurring after blunt trauma: incidence and grading system. Am J Surg. 2009;197(3):413-7. doi: 10.1016/j.amjsurg.2008.11.015.

Esposito TJ, Fedorak I. Traumatic lumbar hernia: case report and literature review. J Trauma. 1994;37(1):123-6.

Belgers HJ, Hulsewé KW, Heeren PA, et al. Traumatic abdominal wall hernia: delayed presentation in two cases and a review of the literature. Hernia. 2005;9(4):388-91. doi: 10.1007/s10029-005-0338-6.

Quraishi AM. Transanal evisceration of bowel loops due to blunt trauma. J Indian Assoc Pediatr Surg 2007;12(4):231-2.

Ganchi PA, Orgill DP. Autopenetrating hernia: a novel form of traumatic abdominal wall hernia--case report and review of the literature. J Trauma. 1996;41(6):1064-6. doi: 10.1097/00005373-199612000-00024.

Dennis RW, Marshall A, Deshmukh H, et al. Abdominal wall injuries occurring after blunt trauma: incidence and grading system. Am J Surg. 2009;197(3):413-7. doi: 10.1016/j.amjsurg.2008.11.015.

Brenneman FD, Boulanger BR, Antonyshyn O. Surgical management of abdominal wall disruption after blunt trauma. J Trauma. 1995;39(3):539-44. doi: 10.1097/00005373-199509000-00023.

Hamidian JA, Skweres J, Sangster G, et al. What we know about management of traumatic abdominal wall hernia: review of the literature and case report. Int Surg. 2015;100(2):233-9. doi: 10.9738/INTSURG-D-13-00239.1.

Rosen MJ, Krpata DM, Ermlich B, et al. A 5-year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh. Ann Surg. 2013;257(6):991-6. doi: 10.1097/SLA.0b013e3182849871.

Yadav S, Jain SK, Arora JK, et al. Traumatic abdominal wall hernia: Delayed repair: Advantageous or taxing. Int J Surg Case Rep. 2013;4(1):36-9. doi: 10.1016/j.ijscr.2012.10.004.

TJS 45-1 04

Downloads

Published

2024-03-29

How to Cite

1.
Supapon T, Wangruttanasopon C. Immediate Exploration of The Traumatic Abdominal Wall Disruption in Children: A Case Report. Thai J Surg [Internet]. 2024 Mar. 29 [cited 2024 Jun. 19];45(1):16-20. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/267529

Issue

Section

Case Reports