The First Reported Case of Morel-Lavallée Lesion and Traumatic Abdominal Wall Hernia: A Case Report and Review of the Literature

Abstract

Rare disease Background: First described in 1863 by French surgeon Victor-Auguste-François Morel-Lavallée, the Morel-Lavallée lesion (MLL) is a closed traumatic soft-tissue degloving injury. These lesions most commonly occur following motor vehicle collisions (MVCs). The pathophysiology stems from a shearing force that causes separation of the soft tissue from the fascia underneath, which disrupts the vasculature and lymphatic vessels that perforate between the tissue layers. Timely diagnosis and treatment are imperative, as a delayed diagnosis can lead to complications. However, at present there is no universally accepted treatment algorithm. Case Report: A 60-year-old morbidly obese woman presented after being involved in an MVC. She complained of abdominal tenderness in the right lower quadrant, with no evidence of peritonitis. Cross-sectional imaging revealed hemoperitoneum and a traumatic posterior abdominal wall/lumbar hernia on the right, with multiple contusions in the subcutaneous abdomen. The patient was taken to the operating room and underwent an exploratory laparotomy that revealed a large abdominal Morel-Lavallée lesion (MLL) along with a traumatic abdominal wall hernia (TAWH). There was also a mesenteric avulsion injury with an associated ileocecal injury. The patient underwent resection of the involved bowel, with primary anastomosis, debridement of the abdominal wall degloving injury, and expectant management for the hernia defect. She recovered from the injuries and was doing well when followed up in the clinic, with follow-up to repair the hernia in the near future. Conclusions: More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.

Traumatic abdominal wall hernia with Morel-Lavallée lesion: a case report

“…Thus, treating MLLs accompanied by infection is challenging. Early surgical debridement of an infected MLL could increase the chances of survival (6,7).…”

A unique soft tissue injury with devastating delayed consequences: A video case report

“…The qualities of this hematoma are suspicious for an uncommon condition called a Morel‐Lavallée lesion (MLL), a closed degloving injury in which the subcutaneous tissues and fascia are separated by a hematoma that forms most frequently because of shearing forces. 1 , 2 Previous reports have documented MLLs secondary to motor vehicle collisions 1 or biking accidents 3 and some in conjunction with traumatic ventral wall hernias. 2 , 4 Diagnosis of this condition can occur through the use of ultrasound or magnetic resonance imaging, demonstrating a heterogenous fluid collection between the subcutaneous tissue and fascia.…”

“… 1 , 2 Previous reports have documented MLLs secondary to motor vehicle collisions 1 or biking accidents 3 and some in conjunction with traumatic ventral wall hernias. 2 , 4 Diagnosis of this condition can occur through the use of ultrasound or magnetic resonance imaging, demonstrating a heterogenous fluid collection between the subcutaneous tissue and fascia. 3 Although early detection of this condition is critical as the patient may continue to hemorrhage during evaluation, sequelae of this condition can be lifethreatening for a patient.…”

Bucket-Handle Mesenteric Tears: A Comprehensive Review of Their Presentation and Management

“…Alternative scoring tools have been proposed, for example, one by Raharimanantsoa and colleagues, which also includes injury mechanisms and associated injuries [ 31 ]. The score is out of 13, with 8 or greater predicting surgically significant blunt bowel and mesenteric injury, and a positive predictive value of 48% [ 15 ]. In the United Kingdom, trauma centres do not currently use scoring tools in blunt abdominal trauma patients routinely, but useful adjunct and prospective databases collecting information from patients with bowel and mesenteric injuries, including bucket-handle tears, could be developed.…”