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Traumatic abdominal wall hernia
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  1. Abhishek Mitra
  1. Bunbury Hospital, Emergency Medicine, 800 Robertson Drive, Bunbury, Western Australia 6230, Australia
  1. Abhishek Mitra, docmitra{at}yahoo.com.au

http://dx.doi.org/10.1136/bcr.10.2008.1171

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    DESCRIPTION

    These abdominal CT images are of a restrained female rear-seat passenger who suffered injuries as a result of a side impact collision at 100 km/h. Clinically she had a soft abdomen with a tender 15×20 cm haematoma on the left flank extending to the left iliac crest. She was haemodynamically stable and appeared to have no other injuries. x Rays of the chest, abdomen and pelvis did not reveal any obvious injury. However, a contrast-enhanced spiral CT revealed rupture of the left lateral wall with herniation of abdominal contents as well as multiple undisplaced pelvic, spinal and rib fractures.

    Figure 1
    Figure 1

    The rupture of the abdominal wall is clearly seen in these images at the level of L2-L3. The large bowel is seen to herniate out of the defect. A small pneumoperitoneum suggests bowel perforation; three small ileal perforations were confirmed on laparotomy.

    Figure 2
    Figure 2

    Coronal section images of the hernia.

    LEARNING POINTS

    • A side impact collision can lead to tangential stresses in the abdominal wall leading to rupture. Obesity and a high-riding lap component of the seat belt have been suggested as risk factors for this kind of injury.1,2

    • CT scan is the only radiological investigation that can aid in the diagnosis of a traumatic hernia and should be used in any stable patient with signs of abdominal injury.1

    Acknowledgments

    Dr Chris Bertke, Consultant Radiologist.

    REFERENCES

    1. ↵
      1. Hickey N,
      2. Ryan M,
      3. Hamilton P,
      4. et al
      . Computed tomography of traumatic abdominal wall hernia and associated deceleration injuries. Can Assoc Radiol J 2002; 53: 153–9.
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    2. ↵
      1. Damschen D,
      2. Landercasper J,
      3. Cobgill T,
      4. et al
      . Acute traumatic abdominal hernia: case Reports. J Trauma 1994; 36: 273–6.
      OpenUrlPubMedWeb of Science

    Footnotes

    • Competing interests: none.

    • Patient consent: Patient/guardian consent was obtained for publication.