Traumatic abdominal wall hernia: a reappraisal.
ABSTRACT Traumatic abdominal wall hernia, a rare cause of hernia, has a confusing clinical picture and requires a high index of suspicion for prompt diagnosis and management. Such hernias, if missed, can result in high morbidity and may prove fatal. Distinction from a pre-existing hernia is important as well. We report our experience in two such cases, which had presented in a span of 9 months, and submit a brief analysis of 50 reviewed cases.
- [Show abstract] [Hide abstract]
ABSTRACT: Abstract Introduction: Ventral hernias may be primary or incisional and classified as midline ventral hernias (MVHs) or non-MVHs (NMVHs). NMVHs are rarer, and their laparoscopic management is technically challenging because of varied anatomic locations, differences in patient positioning at time of surgery, and lack of adequate lateral space for mesh fixation, compounded by the proximity of major organs and bony landmarks. A retrospective review of all the NMVHs operated on in a clinical unit is presented. Subjects and Methods: One hundred eighty-three cases met the criteria of ventral hernia, with 25 cases (13.66%) as NMVH. These NMVHs included lumbar (n=5), suprapubic (n=7), iliac (n=10), and subcostal (n=3). Univariate and multivariate analyses were done using SPSS version 19 software (IBM, Armonk, NY). Continuous data were analyzed using the Mann-Whitney U test/t test, and categorical data were analyzed using the chi-squared test. A P value of ≤.05 was considered significant. Results: Demographic profile and presentation were similar in all groups. One case each had seromuscular intestinal injury in the iliac group (P=.668), splenic injury in the lumbar group, and liver injury in the subcostal group (P=.167). In the iliac group there was 1 patient with hematoma (P=.668), whereas seroma was seen in 1 lumbar group patient and 2 iliac group patients (P=.518). Persistent cough impulse was seen in 1 case each in the iliac and lumbar groups (P=.593). One case in the iliac group recurred after primary surgery (P=.668). Conclusions: NMVHs have a similar spectrum of difficulty and complication profile as those of laparoscopic MVH repairs. Laparoscopic repair of a non-midline hernia is technically challenging but definitely feasible. The incidence of complications and recurrence rate might be more than those for MVHs, but its actual validation needs a much larger comparative study having a longer follow-up.Journal of laparoendoscopic & advanced surgical techniques. Part A. 06/2014;
Article: Handlebar hernia: A misleading termInjury Extra 01/2005; 36(8):309-311.
- [Show abstract] [Hide abstract]
ABSTRACT: The management of traumatic abdominal wall hernias is controversial. We performed a MEDLINE search and report a personal series of 10 patients. Cases were classified according to the cause of injury. Fifty-six percent were caused by car accidents and 14% by bicycle accidents. Diagnosis was clinical in 22% and surgical in 13% and intra-abdominal lesions were found in 67%. Treatment was delayed in 12%. In our series, 55% were lumbar hernias due to traffic accidents and all were associated with pelvic fracture. Treatment was delayed in 50%, including laparoscopic surgery with good results. In conclusion, traumatic hernias due to road traffic accidents are frequently associated with intra-abdominal lesions. The diagnostic technique of choice is computed tomography and delayed surgery (laparoscopy) is an effective option.Cirugia Espanola - CIR ESPAN. 01/2007; 82(5):260-267.