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Patient after blunt abdominal trauma with swelling of the right hemi-abdomen
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Fig1: Patient after blunt abdominal trauma with swelling of the right hemi-abdomen

Mentions: A 59-year-old male sustained a fall from a height of 9 m onto a pile of steel bars, landing on his right flank. Upon arrival of helicopter emergency medical services, the patient was alert and complained of pain in the abdomen. An Advanced Trauma Life Support (ATLS) survey revealed a right-sided pneumothorax, which was treated with a chest tube. After this intervention, the patient was respiratorily and haemodynamically stable and transported to the emergency department. Upon arrival, the initial assessment according to the ATLS protocol was performed without any new findings according to the A, B, C and D approaches. During the secondary survey, the effects of the blunt abdominal trauma were observed. Inspection revealed a large swelling at the right side of the abdomen, with abrasions of the overlying skin (Fig. 1). Palpation of the right abdominal wall was extremely painful. Focussed assessment with sonography for trauma identified the presence of free intraperitoneal fluid around the spleen. An orbital fracture with eyelid laceration was also diagnosed.Fig. 1

Acute traumatic abdominal wall hernia

den Hartog D, Tuinebreijer WE, Oprel PP, Patka P - Hernia (2010)

Bottom Line: We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma.The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan.Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh.

Affiliation: Department of Surgery and Traumatology, Erasmus MC, University Medical Center Rotterdam, Office H-960, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. d.denhartog@erasmusmc.nl

ABSTRACT
Although blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan. Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh. The patient recovered well and the results of a post-operative CT scan are presented.

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