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Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report.

Biswas S, Vedanayagam M, Hipkins G, Leather A - World J Emerg Surg (2010)

Bottom Line: At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis.A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers.To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal.Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Kings College Hospital, Denmark Hill, SE5 9RS, London. seemabiswas@hotmail.com.

ABSTRACT
We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers.To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

No MeSH data available.


Related in: MedlinePlus

Ileum, caecum and appendix reduced.
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Figure 3: Ileum, caecum and appendix reduced.

Mentions: 12 days after admission, repair of the inguinal hernia was performed. At surgery, the external oblique aponeurosis overlying the inguinal canal was contused inferiorly, and the inguinal ligament was found to be sheared off the full length of its attachment from the anterior superior iliac spine to the pubic tubercle, with all boundaries of the canal obliterated (Fig. 2 &3). As a result, instead of dividing the external oblique aponeurosis over the inguinal canal, as in a standard hernia repair, division was performed approximately 10 cm above the level of the inguinal canal where the fibres were intact and there was less contusion and underlying swelling. This revealed the caecum, terminal ileum, appendix and omentum lying directly beneath the external oblique aponeurosis (Fig. 4). There was no visceral ischaemia or perforation. A standard incision over the inguinal canal would, therefore, have been hazardous. Medially, the femoral artery, vein and spermatic cord were all intact and lying freely in the groin, uncontained.


Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report.

Biswas S, Vedanayagam M, Hipkins G, Leather A - World J Emerg Surg (2010)

Ileum, caecum and appendix reduced.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2902452&req=5

Figure 3: Ileum, caecum and appendix reduced.
Mentions: 12 days after admission, repair of the inguinal hernia was performed. At surgery, the external oblique aponeurosis overlying the inguinal canal was contused inferiorly, and the inguinal ligament was found to be sheared off the full length of its attachment from the anterior superior iliac spine to the pubic tubercle, with all boundaries of the canal obliterated (Fig. 2 &3). As a result, instead of dividing the external oblique aponeurosis over the inguinal canal, as in a standard hernia repair, division was performed approximately 10 cm above the level of the inguinal canal where the fibres were intact and there was less contusion and underlying swelling. This revealed the caecum, terminal ileum, appendix and omentum lying directly beneath the external oblique aponeurosis (Fig. 4). There was no visceral ischaemia or perforation. A standard incision over the inguinal canal would, therefore, have been hazardous. Medially, the femoral artery, vein and spermatic cord were all intact and lying freely in the groin, uncontained.

Bottom Line: At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis.A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers.To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal.Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Kings College Hospital, Denmark Hill, SE5 9RS, London. seemabiswas@hotmail.com.

ABSTRACT
We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers.To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

No MeSH data available.


Related in: MedlinePlus