Don’t Forget the Abdominal Wall: Imaging Spectrum of Abdominal Wall Injuries after Nonpenetrating Trauma

Abstract

Abdominal wall injuries occur in nearly one of 10 patients coming to the emergency department after nonpenetrating trauma. Injuries range from minor, such as abdominal wall contusion, to severe, such as abdominal wall rupture with evisceration of abdominal contents. Examples of specific injuries that can be detected at cross-sectional imaging include abdominal muscle strain, tear, or hematoma, including rectus sheath hematoma (RSH); traumatic abdominal wall hernia (TAWH); and Morel-Lavallée lesion (MLL) (closed degloving injury). These injuries are often overlooked clinically because of (a) a lack of findings at physical examination or (b) distraction by more-severe associated injuries. However, these injuries are important to detect because they are highly associated with potentially grave visceral and vascular injuries, such as aortic injury, and because their detection can lead to the diagnosis of these more clinically important grave traumatic injuries. Failure to make a timely diagnosis can result in delayed complications, such as bowel hernia with potential for obstruction or strangulation, or misdiagnosis of an abdominal wall neoplasm. Groin injuries, such as athletic pubalgia, and inferior costochondral injuries should also be considered in patients with abdominal pain after nonpenetrating trauma, because these conditions may manifest with referred abdominal pain and are often included within the field of view at cross-sectional abdominal imaging. Radiologists must recognize and report acute abdominal wall injuries and their associated intra-abdominal pathologic conditions to allow appropriate and timely treatment. RSNA, 2017.

Blunt Transection of the Entire Anterolateral Abdominal Wall Musculature Following Seatbelt-Related Injury

“…The abdominal wall is divided into anterior, lateral, and posterior compartments [5]. The rectus abdominis muscles constitute the anterior compartment.…”

“…Injury is caused by a sudden increase in intra-abdominal pressure and application of extensive shear forces to the abdominal wall. TAWH is typically located at anatomically weak areas of the lower abdomen; lumbar hernias are the most common type of TAWH [5]. Complete transection of the abdominal wall musculature is rare.…”

“…The therapeutic approach varies greatly; patient-tailored (case-by-case) management is required [12,15]. Although no clear consensus on the timing or nature of surgical repair has emerged, several factors must be considered, including defect size, the contents of the hernia, and associated injuries, with special attention being paid to the bowel [5]. If a trauma patient is stable and the hernia is small, with visceral organs protruding through the defect, exploratory laparotomy and/or laparoscopy should be urgently performed to prevent possible visceral incarceration.…”

Rectus sheath hematoma after abdominal trauma with snowball: A case report

“…The detection of fluid densities in the abdomen is suspicious for intraperitoneal rupture. Follow-up ultrasound can also be used for patients requiring long-term follow-up [3]. Hypovolemic shock, infection, abdominal compartment syndrome, myonecrosis, acute renal failure, small bowel infarction, and death have been reported complications of RSH [2].…”

“…Hematoma may occur either by bleeding into the sheath secondary to inferior or superior epigastric artery injury or by primary RAM rupture [1,2]. RSH is usually seen in older women, but younger case reports have also been reported [3]. The most common predisposing factor is the usage of anticoagulant drugs in these elderly patients with cardiac comorbidities.…”