Traumatic abdominal wall injuries—a primer for radiologists

Abstract

Traumatic abdominal wall injuries encompass a broad clinical and radiological spectrum and are identified in approximately 9% of blunt trauma patients. The most severe form of abdominal wall injury—a traumatic abdominal wall hernia—is seen in less than 1.5% of blunt abdominal trauma patients. However, the incidence of concurrent intra-abdominal injuries in these patients is high and can result in significant morbidity and mortality. Although the diagnosis of abdominal wall injuries is typically straight forward on CT, associated injuries may distract the interpreting radiologist in more subtle cases. Thus, it is important for the radiologist to identify abdominal wall injuries and their associated injuries on admission CT, as these injuries typically require surgical correction early in the course of their management. Untreated abdominal wall injuries subject the patient to increased risk of delayed bowel incarceration and strangulation. Therefore, it is important for the radiologist to be knowledgeable of injuries to the abdominal wall and commonly associated injuries to provide optimal patient triage and expedite management.

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References

  1. 1.

    Dennis RW, Marshall A, Deshmukh H, Bender JS, Kulvatunyou N, Lees JS, Albrecht RM (2009) Abdominal wall injuries occurring after blunt trauma: incidence and grading system. Am J Surg 197(3):413–417

    Article  Google Scholar 

  2. 2.

    Matalon SA, Askari R, Gates JD, Patel K, Sodickson AD, Khurana B (2017) Don’t forget the abdominal wall: imaging spectrum of abdominal wall injuries after nonpenetrating trauma. RadioGraphics 37:1218–1235

    Article  Google Scholar 

  3. 3.

    Netto FA, Hamilton P, Rizoli SB, Nascimento B Jr, Brenneman FD, Tien H, Tremblay LN (2006) Traumatic abdominal wall hernia: epidemiology and clinical implications. J Trauma 61(5):1058–1061

    Article  Google Scholar 

  4. 4.

    Brenneman FD, Boulanger BR, Antonyshyn O (1995) Surgical management of abdominal wall disruption after blunt trauma. J Trauma 39(3):539–544

    CAS  Article  Google Scholar 

  5. 5.

    Honaker D, Green J (2014) Blunt traumatic abdominal wall hernias: associated injuries and optimal timing and method of repair. J Trauma Acute Care Surg 77(5):701–770

    Article  Google Scholar 

  6. 6.

    Kulvatunyou N, Albrecht RM, Bender JS, Friese RS, Joseph B, Latifi R, O’Keefe T, Wynn JL, Rhee PM (2011) Seatbelt triad: severe abdominal wall disruption, hollow viscus injury, and major vascular injury. Am Surg 77(5):534–538

    Article  Google Scholar 

  7. 7.

    Coleman JJ, Fitz EK, Zarzaur BL, Steenburg SD, Brewer BL, Reed RL, Feliciano DV (2016) Traumatic abdominal wall hernias: location matters. J Trauma Acute Care Surg 80(3):390–396

    Article  Google Scholar 

  8. 8.

    Belgers HJ, Hulsewé KW, Heeren PA, Hoofwijk AG (2005) Traumatic abdominal wall hernia: delayed presentation in two cases and a review of the literature. Hernia 9(4):388–391

    CAS  Article  Google Scholar 

  9. 9.

    Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM (2010) Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. Trauma Acute Care Surg 68(3):721–733

    Article  Google Scholar 

  10. 10.

    Feliciano DV (2017) Abdominal trauma revisited. Am Surg 83(11):1193–1202

    Article  Google Scholar 

  11. 11.

    Burt BM, Afifi HY, Wantz GE, Barie PS (2004) Traumatic lumbar hernia: report of cases and comprehensive review of the literature. J Trauma 57(6):1361–1370

    Article  Google Scholar 

  12. 12.

    Mahajna A, Ofer A, Krausz MM (2004) Traumatic abdominal hernia associated with large bowel strangulation: case report and review of the literature. Hernia 8(1):80–82

    CAS  Article  Google Scholar 

  13. 13.

    Garrett JW, Braunstein PW (1962) The seat belt syndrome. J Trauma 2:220–238

    CAS  Article  Google Scholar 

  14. 14.

    Ballard DH, Kaskas NM, Jahromi AH, Skweres J, Youssef AM (2014) Abdominal wall hernia and aortic injury secondary to blunt trauma: case report and review of the literature. Int J Surg Case Rep 5(12):1238–1241

    Article  Google Scholar 

  15. 15.

    Goodman P, Balachandran S (1992) CT evaluation of the abdominal wall. Crit Rev Diagn Imaging 33(5):461–493

    CAS  PubMed  Google Scholar 

  16. 16.

    Moore KL, Dalley AF, Agur AMR (2006) Clinically oriented anatomy. 5th ed. Philadelphia: Lippincott Williams & Wilkins xxxiii, 1209 p. p

  17. 17.

    Netter FH (2011) ClinicalKey (online service). Atlas of human anatomy. Philadelphia, Pa.: Saunders/Elsevier

  18. 18.

    Petrosoniak A, Engels PT, Hamilton P, Tien HC (2013) Detection of significant bowel and mesenteric injuries in blunt abdominal trauma with 64-slice computed tomography. J Trauma Acute Care Surg 74(4):1081–1086

    Article  Google Scholar 

  19. 19.

    Steenburg SD, Petersen MJ, Shen C, Lin H (2015) Multi-detector CT of blunt mesenteric injuries: usefulness of imaging findings for predicting surgically significant bowel injuries. Abd Imaging 40:1026–1033

    Article  Google Scholar 

  20. 20.

    Soto JA, Anderson SW (2012) Multidetector CT of blunt abdominal trauma. Radiology 265(3):678–693

    Article  Google Scholar 

  21. 21.

    Connell D, Ali K, Javid M, Bell P, Batt M, Kemp S (2006) Sonography and MRI of rectus abdominis muscle strain in elite tennis players. AJR Am J Roentgen 187:1457–1461

    Article  Google Scholar 

  22. 22.

    Crema MD, Yamada AF, Guermazi A, Roemer FW, Skaf AY (2015) Imaging techniques for muscle injury in sports medicine and clinical relevance. Curr Rev Musculoskelet Med 8:154–161

    Article  Google Scholar 

  23. 23.

    Johnson R (2006) Abdominal wall injuries: rectus abdominis strains, oblique strains, rectus sheath hematoma. Curr Sports Med Rep 5(2):99–103

    Article  Google Scholar 

  24. 24.

    Hatjipetrou A, Anyfantakis D, Kastanakis M (2015) Rectus sheath hematoma: a review of the literature. Int J Surg 13:267–271

    Article  Google Scholar 

  25. 25.

    Wick MC, Klocker J, Grundtman C, Jaschke W, Chemelli AP (2013) Transcatheter embolization for the management of acute active inferior epigastric artery hemorrhages. J Endovasc Ther 20(4):561–567

    Article  Google Scholar 

  26. 26.

    Webb KB, Hadzima S (1987) Hematoma of the rectus abdominis muscle: a complication of subcutaneous heparin therapy. South Med J 80:911–912

    CAS  Article  Google Scholar 

  27. 27.

    Zainea GG, Jordan F (1988) Rectus sheath hematomas: their pathogenesis, diagnosis, and management. Am Surg 54(10):630–633

    CAS  PubMed  Google Scholar 

  28. 28.

    Fukuda T, Sakamoto I, Kohzaki S, Uetani M, Mori M, Fujimoto T, Hayashi K, Matsuo S (1996) Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging 21(1):58–61

    CAS  Article  Google Scholar 

  29. 29.

    Cherry WB, Mueller PS (2006) Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore) 85(2):105–110

    Article  Google Scholar 

  30. 30.

    Bender JS, Dennis RW, Albrecht RM (2008) Traumatic flank hernias: acute and chronic management. Am J Surg 195:414–417

    Article  Google Scholar 

  31. 31.

    Faro SH, Racette CD, Lally JF, Wills JS, Mansoory A (1990) Traumatic lumbar hernia: CT diagnosis. AJR Am J Roentgenol 154:757–759

    CAS  Article  Google Scholar 

  32. 32.

    Hickey NA, Ryan MF, Hamilton PA, Bloom C, Murphy JP, Brenneman F (2002) Computed tomography of traumatic abdominal wall hernia and associated deceleration injuries. Can Assoc Radiol J 53(3):153–159

    PubMed  Google Scholar 

  33. 33.

    Killeen KL, Girard S, DeMeo JH, Shanmuganathan K, Mirvis SE (2000) Using CT to diagnose traumatic lumbar hernia. AJR Am J Roentgenol 174:1413–1415

    CAS  Article  Google Scholar 

  34. 34.

    Esposito TJ, Fedorak I (1994) Traumatic lumbar hernia: case report and literature review. J Trauma 37(1):123–126

    CAS  Article  Google Scholar 

  35. 35.

    Wilson KL, Davis MK, Rosser JC Jr (2012) A traumatic abdominal wall hernia repair: a laparoscopic approach. JSLS. 16(2):287–291

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank medical illustrator Tom Dolan, MS from the University of Kentucky College of Medicine for creating the medical illustration seen in Fig. 1.

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Correspondence to Scott D. Steenburg.

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Author SDS receives research grant support from the Department of the Army (unrelated to the content of this manuscript).

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Steenburg, S.D., Padilla-Jones, B., Lee, J.T. et al. Traumatic abdominal wall injuries—a primer for radiologists. Emerg Radiol 28, 361–371 (2021). https://doi.org/10.1007/s10140-020-01842-w

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Keywords

  • Blunt trauma
  • Traumatic abdominal wall hernia
  • Traumatic abdominal wall rupture
  • Traumatic lumbar hernia