Traumatic abdominal wall hernia in a 12-year-old child: A case report

Abstract

Introduction: Pediatric traumatic abdominal wall hernias pose unique diagnostic and treatment challenges, particularly in cases resulting from blunt injuries. Case presentation: A 12-year-old boy was brought to the emergency room after sustaining a bicycle accident. His vital signs were stable. Physical examination revealed left periumbilical ecchymosis, bruising, and a painful bulge during the Valsalva maneuver. The periumbilical mass was reducible and soft. A computerized tomography (CT) scan revealed a traumatic ventral hernia with a complete disruption of the left rectus muscle and a partial disruption of the right rectus muscle. There was a small amount of free intraperitoneal fluid but no solid organ injuries. The patient was taken urgently to the operating room. Through a midline incision, we confirmed the injuries seen in the CT. We confirmed that there were no bowel injuries. We closed the peritoneum and the posterior rectus sheath with interrupted stitches of number 1 absorbable sutures. We reapproximated the disrupted muscle fibers of the rectus muscles with interrupted stitches of 2.0 absorbable sutures. We lastly repaired the anterior rectus sheath with interrupted stitches of number 1 absorbable sutures. We placed a subcutaneous drain and closed the skin with interrupted stitches of 4.0 non-absorbable sutures. The patient resumed enteral diet on the second postoperative day and was discharged home on the third postoperative day. He has had no recurrence of the hernia at the last follow up. Conclusion: The urgent management of traumatic abdominal wall hernias allows in some cases to avoid using prosthetic material. A layered repair is a safe and effective management option.

Keywords

• Traumatic abdominal wall hernia
• Children
• Case report