Traumatic abdominal wall hernia as part of the seat-belt syndrome: A case report

Abstract text (incl. references and figure legends)

CASE HISTORY

A 34-year-old patient presented at the emergency department after suffering a vehicle collision. He was occupying the co-pilot seat and using the seat belt. The patient was transferred to Tertiary Referral Hospital.

CLINICAL FINDINGS

Initial assessment:

A & B: eupneic, not requiring intubation. C: hypotension that responded quickly after the infusion of 1000 ml of crystalloids. D: Glasgow Score 15/15. E: Abdominal seat belt sign.

INVESTIGATION/RESULTS

Initial gasometry revealed acidosis, haemoglobin 12.6 g/dL and hyperlactacidemia of 3.4 mmol/L. After hemodynamic stabilization, a bodyCT was performed.

DIAGNOSIS

Large posttraumatic hernia M4-5 and L3-4 W3 without active bleeding.

THERAPY AND PROGRESSIONS

The patient became unstable, so we decided to perform an exploratory laparotomy.

A complete section of muscular bellies of the rectus abdominis at the arcuate line was found. Laterally, oblique musculature was also affected, being completely detached from the iliac crest. The patient also had a traumatic section of the rectosigmoid region. There was no active bleeding. Due to the instability, we decided to perform a damage control surgery, performing a packing, resection of damaged colon deferring the anastomosis, and placement of a mesh for fascial traction and ABTHERA© system.

Definitive closure was deferred to POD 4 after 2 looks due to persistence of instability, performing colorectal anastomosis and wall reconstruction: bilateral TAR with placement of Bio-A mesh on the right side due to lack of peritoneum at this level and a polypropylene mesh. The mesh was fixed with bone anchors to iliac crest due to the oblique musculature detachment at this level.

COMMENTS

Optimal management of traumatic hernias remains to be defined. Timing of surgical repair should be based on patient"s stability and concomitant lesions.

REFERENCES

LaPinska, M.P., Lewis, A. (2016). Open Flank Hernia Repair. In: Novitsky, Y. (eds) Hernia Surgery. Springer, Cham.

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