Wilson Kenneth L, Davis Mustafa K, Rosser James C
Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA.
JSLS. 2012 Apr-Jun;16(2):287-91. doi: 10.4293/108680812x13427982377346.
Traumatic abdominal wall hernias from blunt trauma usually occur as a consequence of motor vehicle collisions where the force is tangential, sudden, and severe. Although rare, these hernias can go undetected due to preservation of the skin overlying the hernia defect. Open repairs can be challenging and unsuccessful due to avulsion of muscle directly from the iliac crest, with or without bone loss. A laparoscopic approach to traumatic abdominal wall hernia can aid in the delineation of the hernia and allow for a safe and effective repair.
A 36-year-old female was admitted to our Level 1 trauma center with a traumatic abdominal wall hernia located in the right flank near the iliac crest after being involved in a high-impact motor vehicle collision. Computed tomography and magnetic resonance imaging of the abdomen revealed the presence of an abdominal wall defect that was unapparent on physical examination. The traumatic abdominal wall hernia in the right flank was successfully repaired laparoscopically. One-year follow-up has shown no sign of recurrence.
A traumatic abdominal wall hernia rarely presents following blunt trauma, but should be suspected following a high-impact motor vehicle collision. Frequently, repair is complicated by the need to have fixation of mesh to bony landmarks (eg, iliac crest). In spite of this challenge, the laparoscopic approach with tension-free mesh repair of a traumatic abdominal wall hernia can be accomplished successfully using an approach similar to that taken for laparoscopic inguinal hernia repair.
钝性创伤导致的创伤性腹壁疝通常是机动车碰撞的结果，碰撞力呈切线方向，突然且强烈。尽管此类疝较为罕见，但由于疝缺损上方的皮肤保持完整，可能无法被发现。由于肌肉直接从髂嵴撕脱，无论有无骨质流失，开放修复都可能具有挑战性且不成功。腹腔镜治疗创伤性腹壁疝有助于明确疝的情况，并实现安全有效的修复。
一名36岁女性因卷入一起高冲击力机动车碰撞事故后，右侧腹股沟靠近髂嵴处出现创伤性腹壁疝，被收治入我院一级创伤中心。腹部计算机断层扫描和磁共振成像显示存在腹壁缺损，体格检查时未发现。右侧腹股沟的创伤性腹壁疝通过腹腔镜成功修复。一年随访显示无复发迹象。
钝性创伤后很少出现创伤性腹壁疝，但在高冲击力机动车碰撞后应予以怀疑。通常，修复因需要将补片固定于骨性标志（如髂嵴）而变得复杂。尽管存在这一挑战，但采用类似于腹腔镜腹股沟疝修补术的方法，腹腔镜下无张力补片修复创伤性腹壁疝仍可成功完成。
