An omentum protrusion: a case of traumatic abdominal wall hernia in a child

Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma, especially in the pediatric population. It involves herniation through a disrupted abdominal wall without skin penetration. Its incidence is approximately 0.1%, and diagnosis may be delayed due to subtle clinical signs.

A 4-year-old boy presented with a minor superficial wound after falling onto a vertical iron bar. Initial physical and ultrasound evaluations were unremarkable. One week later, he developed a reducible right lower quadrant abdominal bulge, later confirmed via ultrasound as an omental herniation through a 20 × 10 mm fascial defect. Elective laparotomy revealed omentum prolapse with adhesions, which was repaired with primary suturing. Postoperative recovery was uneventful, and the patient experienced full resolution.

TAWHs are frequently caused by focused blunt trauma, such as bicycle handlebars, and often accompany intra-abdominal injuries. Diagnosis relies on clinical suspicion, imaging (ultrasound or CT), and exclusion of pre-existing hernias. Early surgical repair is recommended to prevent complications like strangulation or incarceration. The case highlights the importance of monitoring and re-evaluation even after initially normal assessments.

TAWH should be suspected in children presenting with abdominal pain after blunt trauma, even when initial findings are minimal. Timely diagnosis and appropriate surgical intervention can prevent morbidity. Due to its rarity, management should be individualized based on patient stability, injury severity, and associated intra-abdominal involvement.