Traumatic abdominal wall hernia

Jump to: navigation, search

WikiDoc Resources for

Traumatic abdominal wall hernia

Articles

Most recent articles on Traumatic abdominal wall hernia

Most cited articles on Traumatic abdominal wall hernia

Review articles on Traumatic abdominal wall hernia

Articles on Traumatic abdominal wall hernia in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Traumatic abdominal wall hernia

Images of Traumatic abdominal wall hernia

Photos of Traumatic abdominal wall hernia

Podcasts & MP3s on Traumatic abdominal wall hernia

Videos on Traumatic abdominal wall hernia

Evidence Based Medicine

Cochrane Collaboration on Traumatic abdominal wall hernia

Bandolier on Traumatic abdominal wall hernia

TRIP on Traumatic abdominal wall hernia

Clinical Trials

Ongoing Trials on Traumatic abdominal wall hernia at Clinical Trials.gov

Trial results on Traumatic abdominal wall hernia

Clinical Trials on Traumatic abdominal wall hernia at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Traumatic abdominal wall hernia

NICE Guidance on Traumatic abdominal wall hernia

NHS PRODIGY Guidance

FDA on Traumatic abdominal wall hernia

CDC on Traumatic abdominal wall hernia

Books

Books on Traumatic abdominal wall hernia

News

Traumatic abdominal wall hernia in the news

Be alerted to news on Traumatic abdominal wall hernia

News trends on Traumatic abdominal wall hernia

Commentary

Blogs on Traumatic abdominal wall hernia

Definitions

Definitions of Traumatic abdominal wall hernia

Patient Resources / Community

Patient resources on Traumatic abdominal wall hernia

Discussion groups on Traumatic abdominal wall hernia

Patient Handouts on Traumatic abdominal wall hernia

Directions to Hospitals Treating Traumatic abdominal wall hernia

Risk calculators and risk factors for Traumatic abdominal wall hernia

Healthcare Provider Resources

Symptoms of Traumatic abdominal wall hernia

Causes & Risk Factors for Traumatic abdominal wall hernia

Diagnostic studies for Traumatic abdominal wall hernia

Treatment of Traumatic abdominal wall hernia

Continuing Medical Education (CME)

CME Programs on Traumatic abdominal wall hernia

International

Traumatic abdominal wall hernia en Espanol

Traumatic abdominal wall hernia en Francais

Business

Traumatic abdominal wall hernia in the Marketplace

Patents on Traumatic abdominal wall hernia

Experimental / Informatics

List of terms related to Traumatic abdominal wall hernia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Awni D. Shahait, M.D.[2], The University of Jordan

Synonyms and keywords: TAWH

Overview

Traumatic Abdominal Wall Hernia (TAWH) represents an infrequent form of hernia and constitutes 1% of hernia cases.[1]

Historical Perspective

The first case was reported by Selby in 1906.

Epidemiology and Demographics

There have been 100 cases reported worldwide. The frequency of cases has increased in the last two decades.[2]

Classification

Traumatic abdominal wall hernia is generally classified into three types [3]

  1. A small abdominal wall defect caused by low-energy trauma with small instruments (e.g. bicycle handlebar)
  2. A larger abdominal wall defect caused by high-energy transfer such as motor vehicle accident or a fall from a height
  3. Iintra-abdominal herniation of bowel with deceleration injures (rare)

Pathophysiology

TAWH is defined as herniation of viscera occurring after a force is applied to the abdomen in a patient without preexisting abdominal hernia, resulting in disruption of muscles and fascia while maintaining skin continuity. [4] The mechanism of TAWH is thought to be caused by shear stress associated with acute elevation of intra-abdominal pressure. The shear stress is transferred to the peritoneum, fascia and muscle fibers which is then followed by tissue rupture. These injuries are mostly located below the umbilicus due to weaker musculature in that region since the rectus sheath is present only above the arcuate line[5]. The hernia may occur at a site fremote from the initial site of trauma.[6] When traumatic insult to the abdominal wall is mainly due to shearing stresses or tensile forces, intra-abdominal injuries are extremely uncommon.[7]

Diagnosis

The criteria for diagnosing TAWH were suggested by McWhorten in 1939, and they are[7]:

  1. Immediate occurrence following blunt trauma
  2. Severe pain at the site of the injury
  3. Patient presents within the first 24 hours
  4. No previous hernia.

Later, these criteria were modified to include:

  1. Intact Skin over the hernia and
  2. No evidence of hernial sac during surgery

Symptoms

The majority of these patients present immediately following the trauma, and 26% present later.[8]

Physical Examination

The classical signs of hernia (i.e., cough impulse and reducibility) are present in only 50% of patients, thus it can be confused with a hematoma. An interesting feature recorded in such a situation is the tendency of such hernias to increase in size over a short period of time.[9] Bowel sounds can occasionally be heard over such a swelling.

Imaging

Computed Tomography (CT) scan showing the disruption in the abdominal wall muscles and fascia with herniation of small bowel loops through it.

Ultrasound of the abdominal wall is still widely used because of its availability and relatively low cost. For the first evaluation in the emergency room, ultrasound is easily accessible and can be helpful in establishing the primary diagnoses.[10] However, the sensitivity and specificity of the CT scan is much higher and also enables better imaging of the abdominal wall and the intra-abdominal organs which is of interest in the abdominal trauma patient. At present, CT scan is the standard for diagnosing of any form of abdominal wall hernia since the relationship between the different muscle layers and surrounding structure is better visualized.[11]

Treatment

Surgical intervention remains the mainstay of management in these patients[6], although conservative management has been reported in the literature.[1] There is controversy as to whether to operate immediately or later. The majority of surgeons prefer to operate immediately, and some after a period of conservative management. The timing of surgery depends on the following considerations:

  • Surgeon preference
  • The timing of presentation
  • Comorbidities and fitness for surgery
  • The presence of complications
  • The hemodynamic status and severity of associated injuries

Complications that should be avoided with surgery include incarceration and strangulation of the bowels.[8]

Despite the trend to use the laparoscopic approach in treatment of incisional hernias, it infrequently practiced in cases of TAWH.[12] Open surgery was selected in most of the reported cases in the literature. Debates exist on whether to use a midline incision or an incision over the hernia. In the majority, midline incision was chosen in acute cases, to rule out associated intra-abdominal injury which occurs in about 30 % to 44% of patients in high energy trauma.[13] While in low energy induced TAWH, local exploration through an incision over the hernia is preferred.[3]

The main goal of surgery is reconstruct the disruption of the abdominal wall, which can be achieved either by primary closure or by applying a mesh. It depends on the size and site of hernia, associated intra-abdominal injury and timing of intervention.[2] In TAWH induced by low energy, a primary repair, by approximation of the defect using non-absorbable sutures, was the first choice, because in these cases the soft tissue damage and defect size is minimal.[14] On the other hand, in high energy TAWH, the defect size is usually larger and tissue loss is greater, which can’t be repaired primarily. So mesh is preferred, with additional benefit by decreasing the recurrence rate. But not to forget the increased risk of infections in these circumstances.[15]

References

  1. 1.0 1.1 Netto FA, Hamilton P, Rizoli SB, et al. (November 2006). "Traumatic abdominal wall hernia: epidemiology and clinical implications". J Trauma 61 (5): 1058–61. doi:10.1097/01.ta.0000240450.12424.59. PMID 17099509.
  2. 2.0 2.1 Yücel N, Uğraş MY, Işık B, Turtay G (November 2010). "Case report of a traumatic abdominal wall hernia resulting from falling onto a flat surface". Ulus Travma Acil Cerrahi Derg 16 (6): 571–4. PMID 21153955.
  3. 3.0 3.1 Wood RJ, Ney AL, Bubrick MP (November 1988). "Traumatic abdominal hernia: a case report and review of the literature". Am Surg 54 (11): 648–51. PMID 2973272.
  4. Hardcastle TC, Du Toit DF, Malherbe C, et al. (May 2005). "Traumatic abdominal wall hernia--four cases and a review of the literature". S Afr J Surg 43 (2): 41–3. PMID 16035382.
  5. Gill IS, Toursarkissian B, Johnson SB, Kearney PA (July 1993). "Traumatic ventral abdominal hernia associated with small bowel gangrene: case report". J Trauma 35 (1): 145–7. PMID 8331706.
  6. 6.0 6.1 Ganchi PA, Orgill DP (December 1996). "Autopenetrating hernia: a novel form of traumatic abdominal wall hernia--case report and review of the literature". J Trauma 41 (6): 1064–6. PMID 8970567.
  7. 7.0 7.1 Damschen DD, Landercasper J, Cogbill TH, Stolee RT (February 1994). "Acute traumatic abdominal hernia: case reports". J Trauma 36 (2): 273–6. PMID 8114153.
  8. 8.0 8.1 Kumar A, Hazrah P, Bal S, Seth A, Parshad R (August 2004). "Traumatic abdominal wall hernia: a reappraisal". Hernia 8 (3): 277–80. doi:10.1007/s10029-003-0203-4. PMID 14735329.
  9. Al-Qasabi QO, Tandon RC (June 1988). "Traumatic hernia of the abdominal wall". J Trauma 28 (6): 875–6. PMID 3385839.
  10. Losanoff JE, Richman BW, Jones JW (March 2002). "Handlebar hernia: ultrasonography-aided diagnosis". Hernia 6 (1): 36–8. PMID 12090580.
  11. Hickey NA, Ryan MF, Hamilton PA, Bloom C, Murphy JP, Brenneman F (June 2002). "Computed tomography of traumatic abdominal wall hernia and associated deceleration injuries". Can Assoc Radiol J 53 (3): 153–9. PMID 12101537.
  12. Munshi IA, Ravi SP, Earle DB (2002). "Laparoscopic repair of blunt traumatic anterior abdominal wall hernia". JSLS 6 (4): 385–8. PMID 12500842.
  13. Singh R, Kaushik R, Attri AK (June 2004). "Traumatic abdominal wall hernia". Yonsei Med. J. 45 (3): 552–4. PMID 15227747.
  14. Iinuma Y, Yamazaki Y, Hirose Y, et al. (January 2005). "A case of a traumatic abdominal wall hernia that could not be identified until exploratory laparoscopy was performed". Pediatr. Surg. Int. 21 (1): 54–7. doi:10.1007/s00383-004-1264-x. PMID 15365743.
  15. Lane CT, Cohen AJ, Cinat ME (January 2003). "Management of traumatic abdominal wall hernia". Am Surg 69 (1): 73–6. PMID 12575786.

Linked-in.jpg