DESCRIPTION
These abdominal CT images are of a restrained female rear-seat passenger who suffered injuries as a result of a side impact collision at 100 km/h. Clinically she had a soft abdomen with a tender 15×20 cm haematoma on the left flank extending to the left iliac crest. She was haemodynamically stable and appeared to have no other injuries. x Rays of the chest, abdomen and pelvis did not reveal any obvious injury. However, a contrast-enhanced spiral CT revealed rupture of the left lateral wall with herniation of abdominal contents as well as multiple undisplaced pelvic, spinal and rib fractures.
Figure 1.
The rupture of the abdominal wall is clearly seen in these images at the level of L2-L3. The large bowel is seen to herniate out of the defect. A small pneumoperitoneum suggests bowel perforation; three small ileal perforations were confirmed on laparotomy.
Figure 2.
Coronal section images of the hernia.
LEARNING POINTS
A side impact collision can lead to tangential stresses in the abdominal wall leading to rupture. Obesity and a high-riding lap component of the seat belt have been suggested as risk factors for this kind of injury.1,2
CT scan is the only radiological investigation that can aid in the diagnosis of a traumatic hernia and should be used in any stable patient with signs of abdominal injury.1
Acknowledgments
Dr Chris Bertke, Consultant Radiologist.
Footnotes
Competing interests: none.
Patient consent: Patient/guardian consent was obtained for publication.
REFERENCES
- 1.Hickey N, Ryan M, Hamilton P, et al. Computed tomography of traumatic abdominal wall hernia and associated deceleration injuries. Can Assoc Radiol J 2002; 53: 153–9 [PubMed] [Google Scholar]
- 2.Damschen D, Landercasper J, Cobgill T, et al. Acute traumatic abdominal hernia: case Reports. J Trauma 1994; 36: 273–6 [DOI] [PubMed] [Google Scholar]
