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Traumatic abdominal wall hernias in children: A case for early exploration

Niloufar Hafezi1, Jodi L Raymond2, Erin D Mayo2

  • 1Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA.

Journal of Pediatric Surgery
|August 6, 2020
PubMed

Insights

Traumatic abdominal wall hernias (TAWH) in children are rare after blunt abdominal trauma (BAT), often associated with significant intra-abdominal injuries. Early surgical exploration is recommended due to low CT scan accuracy for detecting these concurrent injuries.

Area of Science:

  • Pediatric Surgery
  • Trauma Surgery
  • Abdominal Imaging

Background:

  • Traumatic abdominal wall hernia (TAWH) is an uncommon injury resulting from blunt abdominal trauma (BAT).
  • Understanding TAWH in pediatric patients is crucial for effective management and outcome prediction.

Purpose of the Study:

  • To determine the frequency of TAWH in children following BAT.
  • To evaluate the rate of concurrent intra-abdominal injuries (CAI) associated with TAWH.
  • To assess the diagnostic accuracy of CT scans and analyze management strategies and outcomes for TAWH.

Main Methods:

  • A retrospective review of a Level 1 pediatric trauma center registry was conducted.
  • Data from children under 18 years old with TAWH from BAT between 2009 and 2019 were analyzed.
  • Incidence, associated injuries, CT findings, and treatment outcomes were examined.

Main Results:

  • TAWH occurred in 11 out of 9370 pediatric BAT patients (0.1% incidence).
  • Over 64% of patients with TAWH had concurrent intra-abdominal injuries requiring intervention.
  • CT scan sensitivity and specificity for detecting associated injuries were low (20% and 50%, respectively).

Conclusions:

  • Pediatric patients with TAWH exhibit a high incidence of concurrent intra-abdominal injuries necessitating surgical repair.
  • CT imaging demonstrates limited utility in diagnosing associated injuries in TAWH cases.
  • A high index of suspicion and a low threshold for surgical exploration are essential for managing pediatric TAWH.
Abstract

Keywords:
Abdominal disruptionPediatricTraumatic abdominal wall herniaTraumatic hernia

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