Traumatic Abdominal Wall Hernia

Michael P. Federle, MD, FACR

Kathleen E. Jacobs, BA

Key Facts

Terminology

Traumatic disruption of musculature & fascia of anterior abdominal wall without skin penetration

Imaging

May be diffuse or focal disruption
Iliac crest region > anterior abdominal wall > inguinal > retroperitoneal
Differing patterns of muscular & fascial disruption
- Due to different types of forces involved & tensile properties of various areas in abdominal wall
All layers of muscle and fascia are usually involved
CT shows size and site of defect; hernia contents
- Depicts associated visceral injuries

Top Differential Diagnoses

Other hernias
- May have similar appearance; differ by etiology

Pathology

Sudden ↑ in intraabdominal pressure in combination with direct impact, disrupting abdominal wall
- Shearing force applied across bony prominences (e.g., iliac crest)
- High-energy injuries: Motor vehicle accidents; seat belts increase risk
- Low-energy injuries: Impact on small blunt object (e.g., bicycle handlebar)
Bowel mesenteric, pancreatic, and other visceral injuries are very likely

Clinical Issues

Abdominal skin ecchymosis or abrasions (“seat belt” ecchymosis)
Treatment: High-energy injuries = immediate exploratory laparotomy to treat visceral injuries

(Left) Axial CECT in a 52-year-old man injured in a motor vehicle crash shows the abdominal wall muscles are avulsed from their insertion on the iliac crest, with hemorrhage and herniation of the ascending colon and fat

. (Right) Axial CECT in the same patient shows the avulsion of the abdominal muscles from their insertion on the iliac crest, with herniation of the ascending colon