A 62 y.o. woman was in a headon crash with a truck. She was a restrained driver and airbags deployed

She complained of abdominal pain. Do you see why? The FAST scan was negative.

Our patient had a traumatic abdominal hernia in the LLQ.  There was also a mesenteric root injury.  She dropped her BP to 60 and was taken to the OR.

Traumatic abdominal wall hernias are uncommon and occur in two basic types. One is caused by sudden increase in intra-abdominal pressure caused by high energy impacts as in our patient.  The other is caused by a lower energy exerted by a a blunt object with a small surface such as a handlebar.. While the injury in our patient was not subtle; they can be easily missed.

traumatic hernia from high energy impact.

handlebar hernia from low energy localized impact

Hernias which are not traumatic are more familiar to most physicians.

The major types are:

Umbilical-congenital umbilical hernias occur in 15% of newborns

Epigastric- these hernias are more common when there is a diastasis recti since the linea alba is weakened in both.

Inguinal- affect 25% of all men at birth

Spigelian- is a type of ventral hernia which occurs not under abdominal fat but between fascia tissue at the lateral border of the rectus muscle.  They are small and at risk for strangulation.

Lumbar hernias  occur in the back under the external oblique or 12th rib.

Our patient recovered after a prolonged stay in the ICU.

FUN FACT

Did you know six pack abs are just the rectus abdominus with bands of connective tissue across them .If you work out and  your body fat is 7-15% you will see them.   In some cases congenital mismatch occurs and they are “staggered”?

there is no cure for staggered abs

Akbaba S, Gundogdu R, Temel H, et al. Traumatic abdominal wall hernia: early or delayed repair? Indian J Surg. 2014 May7;77(Suppl 3):963-966.

Bejiga G. Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: a ‘case report” International Journal of Surgery Case Reports  .2023 Vol 105 https://doi.org/10.1016/j.ijscr.2023.107981

Niknejad M. Lumbar hernia.  Radiopaedia, Jan 9 2024, https://radiopaedia.org/articles/lumbar-hernia?lang=us

Sundaramurthy S,Suresh H, Anirudh A, et al. Primary lumbar hernia: a rarely encountered hernia. International J of Surg Case Reports 2016 vol 20:53-56.