Traumatic ventral hernia

Traumatic Abdominal Wall Hernia in Children: A Systematic Review

BACKGROUND

Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature to describe injuries, management, and outcomes.

MATERIALS AND METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed, Web of Science, Embase, and Google Scholar was performed to identify English-language publications of blunt TAWH in patients <18 y old. Conflicts were resolved by consensus. Data were collected on demographics, associated injuries, management, and outcomes.

RESULTS

A total of 71 articles were reviewed with 100 cases of TAWH. A total of 82.5% of patients were male, and the median age was 9 y old (range 2-15). Injury by bicycle handlebars was most common (72%) followed by motor vehicle collision (14%). Forty patients had intraabdominal injuries, most commonly bowel (70%) or mesentery (37.5%). Rate of intraabdominal injury was significantly higher in patients with injuries due to nonbicycle handlebar injuries when compared with bicycle handlebar injuries (60.7% versus 33.3%, P = 0.02). Most patients were managed operatively (85%), most commonly via laparotomy (68/85, 80%), with six laparoscopic repairs and five laparoscopic converted to open repairs. There were three reported complications and no recurrences over a median of follow-up of 5 mo in patients who underwent repair.

CONCLUSIONS

Pediatric TAWH is a rare injury with a high rate of intraabdominal injuries, particularly when due to high-impact mechanisms such as motor vehicle collision. Although open repair is more commonly performed, laparoscopic repair has been described with success. Recurrence rates appear low, but follow-up has been short term.

Laparoscopic-assisted management of traumatic abdominal wall hernias in children: case series and a review of the literature

BACKGROUND

Traumatic abdominal wall hernia (TAWH) is defined as herniation through a disrupted portion of musculature/fascia without skin penetration or history of prior hernia. In children, TAWH is a rare injury.

OBJECTIVE

The objectives of this study were to report our experience with different management strategies of TAWH in children and to determine the utility of laparoscopy.

DESIGN/METHOD

A retrospective chart review of all children treated by pediatric surgery at our institution for TAWH in a 5year interval was performed. Data were collected on mechanism of injury, initial patient presentation, surgical management, and outcomes.

RESULTS

We present 5 cases of traumatic abdominal wall hernia; 3 were managed using laparoscopic assistance. One patient was managed nonoperatively. All patients recovered without complications and were asymptomatic on follow up.

CONCLUSION

Traumatic abdominal wall hernias require a high index of suspicion in the cases of blunt abdominal trauma. Laparoscopy is useful mainly as a diagnostic modality, both to evaluate the hernia and associated injuries to intraabdominal structures. Its use may facilitate repair through a smaller incision. Conservative management of TAWH may be appropriate in select cases where there is a low risk of bowel strangulation.

Handlebar hernia: a case report and literature review on traumatic abdominal wall hernia in children

A rare case of abdominal trauma, a handlebar hernia, is described, as well as a review of the pertinent literature. A 7-year-old boy presented to our emergency room after sustaining blunt force to the abdomen; he fell on the handlebar of his bicycle. Immediately after the accident, a bulge was noticeable at the point of impact. Handlebar hernia is a diagnosis that is easily missed, which can lead to strangulation and incarceration of the bowel. With this case report, we hope to augment the knowledge on traumatic abdominal wall hernia, hopefully leading to early diagnosis and treatment.

A case of a traumatic abdominal wall hernia that could not be identified until exploratory laparoscopy was performed

Traumatic abdominal wall hernia (TAWH) is a rare condition secondary to blunt abdominal trauma in children. We herein report an 8-year-old boy who developed TAWH after falling onto a bicycle handlebar. Neither physical examination nor radiological findings suggested a diagnosis of TAWH at first presentation. TAWH in the right lower quadrant could not be identified until exploratory laparoscopy was performed. An open surgical repair was done, and the postoperative course was uneventful. The literature on pediatric TAWH is briefly reviewed and the findings discussed.

Blunt abdominal trauma

Images

Handlebar hernia: diagnosis by abdominal computed tomography

Traumatic "handlebar" hernia, produced by impaction of a bicycle handlebar on the abdominal wall, is a rare entity. Presented is the case of a 7-year-old boy who sustained such a hernia, which contained an incarcerated loop of small bowel. The use of abdominal computed tomography to confirm the diagnosis before operative reduction of the hernia appears to be a safe and efficacious adjunct to physical examination.