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

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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

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

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

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Footnotes

  • Competing interests: none.

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

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