Post-traumatic lateral abdominal wall hernia: a case report

Abstract

Introduction and importance: Traumatic abdominal wall hernia (TAWH) also known as blunt abdominal TAWH is uncommon. The clinical diagnosis is difficult. The authors present a case report of posthigh-energy abdominal blunt trauma causing a TAWH. Case presentation: A 36-year-women, with unremarkable past medical history, was presented to the Emergency Department after a stuck in high-speed two automobiles. She was hemodynamic, respiratory, and neurologically stable. The BMI was 36 kg/m². The abdomen was not distended with an ecchymotic lesion on the right flank. The thoracic abdominal and pelvic computed tomography (CT) scan revealed a rupture in the lateral abdominal wall muscles with a TAWH in the location of the skin ecchymoses. There was no visceral lesion or intraperitoneal fluid. A conservative treatment was indicated. The follow-up was uneventful, with hematoma resorption and no cellulitis or abscess. The patient was discharged after 1 week. An abdominal repair will be planned using a mesh. Clinical discussion: TAWH is a rare entity. The best imaging modality for diagnosis is the CT scan allowing classification of the hernia and a screen for other injuries. The presence of an isolated TAWH must lower the threshold to closely monitor or to operatively explore, given the high rate of false-negative findings at imaging features. Conclusion: TAWH should be suspected behind any blunt abdominal trauma with high energy. CT scan and ultrasound were helpful for diagnosis and the only curative treatment is surgery to avoid complications.