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

Abstract

The prevalence of traumatic abdominal wall hernias (TAWHs) after blunt abdominal trauma is approximately 1%. When TAWHs are accompanied by a Morel-Lavallée lesion (MLL), a closed traumatic injury involving soft tissue degloving, affected patients become susceptible to severe soft tissue infection, which necessitates challenging treatments. However, no guidelines regarding an optimal management strategy have been published. Here we describe the successful treatment of a TAWH accompanied by an MLL in the anterior lower abdomen of a 66-year-old woman who sustained a seatbelt injury after a traffic accident while driving.

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“… 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.…”

“…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 3 .…”

シートベルト損傷によるMorel–Lavallée lesionの1症例(A case of Morel–Lavallée lesion due to seatbelt injury)

“…MLLは，外傷後の閉鎖性デグロービング軟部組織損傷であり，1863年にフランスの外科医Morel–Lavalléeによって最初に報告された 3), 4), 5)。病変は，強い剪断応力によって引き起こされ，可動性を有する表在性皮下組織が硬い下層筋膜から剥がれてできた潜在的なスペースに，損傷した小血管およびリンパ管から血液，リンパ液，壊死性脂肪組織が溜まり，患部に腫脹として現れる 3), 4), 5)。主な原因は高エネルギー外傷で，自動車事故が25%を占める 6)が，フットボールやレスリングなどのスポーツ傷害でも発症する 5), 7)。我々の調べた限りでは，シートベルトによるMLLの報告はこれまでにDallaudièreら 8)とHeoら 9)の2例のみであり，本邦では本症例が初の報告である。…”