Abstract | December 19, 2022
Traumatic Abdominal Hernia Management using Component Separation and Synthetic and Biological Mesh
Learning Objectives
- Traumatic Abdominal Wall Hernia's may be easily missed on imaging and physical exam findings, and can lead to significant morbidity/mortality, thus the importance of early clinical suspicion in patients who have suffered high impact blunt abdominal trauma is increasingly important.
Introduction: When patients experience trauma, a myriad of different medical complications may ensue, the most concerning of which include cardiovascular collapse secondary to acute hemorrhage. Rarely do hernias become a principal concern in the setting of a traumatic injury. Traumatic abdominal wall hernias (TAWH) are rare complications of blunt abdominal trauma. Of the various TAWH a rare subtype noted as a “spontaneous lateral ventral hernia” or spigelian hernia occur in less than 1% of all blunt abdominal traumas. As there is currently no clear gold standard in the repair of TAWH, quick improvision is required to ensure there is appropriate closure of the abdominal wall defect.
Case Presentation: A 39 year old male with a past medical history of epilepsy, was brought in by ambulance after being involved in a rollover MVA. The patient was reported to have had a seizure while driving. On physical exam it was noted the patient had a malrotated left ankle along with an absent left dorsalis pedis pulse, and large left lower flank contusion.
Final working diagnosis: Once hemodynamically stable the patient was taken for a complete body Computed Tomography with intravenous contrast. Imaging studies were notable for a left lateral abdominal wall hematoma, left lateral abdominal hernia, comminuted left distal femur fracture, left fibula fracture, and no noted vascular injuries.
Management/Outcome: The patient was noted to have a complex TAWH/Spinglen hernia requiring an open surgical fixation. An incision was made over the defect. The external oblique was divided lateral to linea semilunaris, vertically and separated from the internal oblique. There was complete tearing of the abdominal obliques from the iliac crest with near to total disruption of the internal oblique. The underlying bowel contents were examined and noted to be intact without any injury. The complete obliteration of the left lateral wall provided difficulty with the repair. A biologic mesh was used with reinforcement provided by the synthetic VentralightTM mesh with reinforcement to the iliac crest. The patient progressed with his physical therapy over the next few postoperative days and was discharged from the hospital in stable condition by postoperative day 13.
References:
- Dennis RW, Marshall A, Deshmukh H, et al.: Abdominal wall injuries occurring after blunt trauma: incidence and grading system. Am J Surg. 2009, 197:413-417. 10.1016/j.amjsurg.2008.11.015
- Mittal T, Kumar V, Khullar R, et al. Diagnosis and management of Spigelian hernia: A review of literature and our experience. J Minim Access Surg. 2008;4(4):95-98. doi:10.4103/0972-9941.45204
- Donovan K, Denham M, Kuchta K, et al. Laparoscopic totally extraperitoneal and transabdominal preperitoneal approaches are equally effective for spigelian hernia repair. Surg Endosc. 2021;35(4):1827-1833. doi:10.1007/s00464-020-07582-9
