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

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.