Traumatic abdominal wall hernia: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
TAWH is defined as herniation of viscera occurring after a force is applied | 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. <ref name="pmid16035382">{{cite journal |author=Hardcastle TC, Du Toit DF, Malherbe C, ''et al.'' |title=Traumatic abdominal wall hernia--four cases and a review of the literature |journal=S Afr J Surg |volume=43 |issue=2 |pages=41–3 |year=2005 |month=May |pmid=16035382 |doi= |url=}}</ref> 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<ref name="pmid8331706">{{cite journal |author=Gill IS, Toursarkissian B, Johnson SB, Kearney PA |title=Traumatic ventral abdominal hernia associated with small bowel gangrene: case report |journal=J Trauma |volume=35 |issue=1 |pages=145–7 |year=1993 |month=July |pmid=8331706 |doi= |url=}}</ref>. The hernia may occur at a site fremote from the initial site of trauma.<ref name="pmid8970567">{{cite journal |author=Ganchi PA, Orgill DP |title=Autopenetrating hernia: a novel form of traumatic abdominal wall hernia--case report and review of the literature |journal=J Trauma |volume=41 |issue=6 |pages=1064–6 |year=1996 |month=December |pmid=8970567 |doi= |url=}}</ref> When traumatic insult to the abdominal wall is mainly due to shearing stresses or tensile forces, intra-abdominal injuries are extremely uncommon.<ref name="pmid8114153">{{cite journal |author=Damschen DD, Landercasper J, Cogbill TH, Stolee RT |title=Acute traumatic abdominal hernia: case reports |journal=J Trauma |volume=36 |issue=2 |pages=273–6 |year=1994 |month=February |pmid=8114153 |doi= |url=}}</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 17:02, 14 April 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Awni D. Shahait, M.D., 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]
- A small abdominal wall defect caused by low-energy trauma with small instruments (e.g. bicycle handlebar)
- A larger abdominal wall defect caused by high-energy transfer such as motor vehicle accident or a fall from a height
- 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]:
- Immediate occurrence following blunt trauma
- Severe pain at the site of the injury
- Patient presents within the first 24 hours
- No previous hernia.
Later, these criteria were modified to include:
- Intact Skin over the hernia and
- No evidence of hernial sac during surgery
Treatment
References
- ↑ Netto FA, Hamilton P, Rizoli SB; et al. (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. Unknown parameter
|month=ignored (help) - ↑ Yücel N, Uğraş MY, Işık B, Turtay G (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. Unknown parameter
|month=ignored (help) - ↑ Wood RJ, Ney AL, Bubrick MP (1988). "Traumatic abdominal hernia: a case report and review of the literature". Am Surg. 54 (11): 648–51. PMID 2973272. Unknown parameter
|month=ignored (help) - ↑ Hardcastle TC, Du Toit DF, Malherbe C; et al. (2005). "Traumatic abdominal wall hernia--four cases and a review of the literature". S Afr J Surg. 43 (2): 41–3. PMID 16035382. Unknown parameter
|month=ignored (help) - ↑ Gill IS, Toursarkissian B, Johnson SB, Kearney PA (1993). "Traumatic ventral abdominal hernia associated with small bowel gangrene: case report". J Trauma. 35 (1): 145–7. PMID 8331706. Unknown parameter
|month=ignored (help) - ↑ Ganchi PA, Orgill DP (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. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 Damschen DD, Landercasper J, Cogbill TH, Stolee RT (1994). "Acute traumatic abdominal hernia: case reports". J Trauma. 36 (2): 273–6. PMID 8114153. Unknown parameter
|month=ignored (help)