Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA.
Pediatr Surg Int. 2021 Apr;37(4):511-517. doi: 10.1007/s00383-020-04796-9. Epub 2021 Jan 1.
Blunt impact-induced traumatic abdominal wall hernia (TAWH) is an uncommon pediatric surgical problem classically associated with handlebar injury but increasingly seen with seatbelt use in motor vehicle collisions (MVC). Herein we describe the largest case series of pediatric TAWH to date and review the literature to establish the unique syndromic characteristics of MVC-associated TAWH.
In this single-institution series, we discuss four pediatric patients, all with seatbelt-associated TAWH after high-speed MVC characterized by full-thickness disruption of the lateral abdominal wall. We then performed a review of the literature to identify additional pediatric MVC-associated TAWH and define the characteristics of patients who sustained this unique injury.
In addition to the four patients in our case series, five additional pediatric patients presenting with TAWH after restrained MVC were identified in the literature. Of these nine patients, eight (89%) presented with an obvious seatbelt sign (bruising/laceration to the abdominal wall). Six (67%) had associated injuries typical of the seatbelt syndrome, including four spinal flexion injuries (44%) and five bowel injuries requiring repair or resection (56%). Overall, 56% of seatbelt-associated TAWH occurred in children with a BMI percentile > 95%.
In this case series and literature review, we note a high rate of seatbelt syndrome injuries in pediatric patients presenting with TAWH after restrained MVC. Suspicion for TAWH should be high in children presenting with a seatbelt sign and should trigger a low threshold for pursuing additional axial imaging.
Level IV; case series.
钝性撞击导致的创伤性腹壁疝（TAWH）是一种罕见的小儿外科问题，通常与车把伤有关，但在机动车碰撞（MVC）中越来越多地与安全带使用有关。在此，我们描述了迄今为止最大的小儿 TAWH 病例系列，并回顾了文献，以确定 MVC 相关 TAWH 的独特综合征特征。
在这个单机构系列中，我们讨论了 4 名小儿患者，他们均因高速 MVC 导致安全带相关 TAWH，其特征是侧腹壁全层破裂。然后，我们对文献进行了回顾，以确定其他小儿 MVC 相关 TAWH 并定义发生这种独特损伤的患者特征。
除了我们病例系列中的 4 名患者外，文献中还确定了另外 5 名因约束性 MVC 而出现 TAWH 的小儿患者。这 9 名患者中，有 8 名（89%）出现明显的安全带征（腹壁瘀伤/撕裂）。有 6 名（67%）存在典型的安全带综合征相关损伤，包括 4 名脊柱屈曲损伤（44%）和 5 名肠损伤需要修复或切除（56%）。总体而言，56%的安全带相关 TAWH 发生在 BMI 百分位数大于 95%的儿童中。
在本病例系列和文献回顾中，我们注意到在因约束性 MVC 而出现 TAWH 的小儿患者中，安全带综合征损伤的发生率很高。在出现安全带征的儿童中，应高度怀疑 TAWH，并应降低进一步进行轴向成像检查的门槛。
IV 级；病例系列。
