Traumatic Lumbar Hernia Due to Seat Belt Injury

Balkan, Müjdat; Kozak, Orhan; Güleç, Bülent; Taşar, Mustafa; Pekcan, Mesut

doi:10.1097/00005373-199907000-00031

Cited by 32 publications

(11 citation statements)

References 8 publications

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“…1 Given the extent of other injuries at the time of presentation, as in our patient's case, it is not uncommon that the degree of abdominal wall disruption is not initially appreciated. Ultrasound scan was a reasonable first line assessment tool in our patient's case.…”

Section: Discussionmentioning

confidence: 68%

“…The case described by Balkan et al 1 had a delay of 2 days following admission to hospital for observations. Classic clinical signs include flank eccymoses and/or haematomas, protruding bulges, localized pain or referred pain to either anterior abdominal wall or via sciatic nerve.…”

Section: Discussionmentioning

confidence: 97%

“…Another recent case report by Balkan et al 1 in 1999 describes a traumatic lumbar hernia also attributed to the wearing of a seat-belt. In that case there was a delay of 2 days before diagnosis and the patients' hernia became strangulated leading to bowel resection and formation of a colostomy.…”

Section: Discussionmentioning

confidence: 98%

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A unique presentation and repair of a traumatic lumbar hernia

2005

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 97%

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A unique presentation and repair of a traumatic lumbar hernia

2005

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“…Along with infection and surgical causes, these acquired hernias represent 25% of all lumbar hernias. 2 Previous authors have postulated that this may represent a form of seat belt injury, especially in obese patients, subject to deceleration type forces to the abdominal wall musculature with a high riding seat belt and subsequent muscle tear or avulsion from insertions. 3,4 The diagnosis is made largely by a combination of clinical factors with radiologic support.…”

Section: Discussionmentioning

confidence: 99%

Meningitis Complicating Traumatic Lumbar Herniation

Rizzo

Günther

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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T he views expressed in this article are those of the authors and do not reflect the official policy or position of the department of the Navy, Department of Defense, or the United States Government.Lumbar herniation is rare in the trauma setting, often associated with other intra-abdominal pathology, and may represent a severe form of seat belt injury. As these hernias have a propensity toward incarceration and strangulation, early diagnosis is crucial to prevent death and complications. We report an unusual case of death from Eschericia coli meningitis after strangulation of the sigmoid colon in a traumatic lumbar hernia. CASE SUMMARYThe patient, a 30-year-old obese female, was the restrained passenger in a rollover motor vehicle collision. Initial evaluation revealed a closed head injury with normal head computed tomography (CT), multiple fractures of the transverse and spinous processes of the thoracic and lumbar spine, open book pelvis fracture, right femur fracture, and a large left flank hematoma. Four days after admission, she was noted to have altered mental status, and was febrile to 105 degrees. Blood cultures revealed gram-negative rods on Gram's stain and the patient was then transferred to our institution. Repeat CT scan of the abdomen (Fig. 1) documented a left lumbar hernia containing bowel, associated with a large flank hematoma containing air. At operation, a strangulated portion of sigmoid colon was identified in the large posterior hernia defect. Hartman's procedure with incision and debridement of the flank wound was performed. The hernia defect was obliterated by closing muscle and peritoneal defects. Prosthetic material was not used in the face of gross fecal contamination. Operative cultures of the flank wound were positive for E. coli. Postoperatively she underwent frequent operation for wound washout, debridement, and packing. Unfortunately her course was complicated by persistent E. coli sepsis, multisystem organ failure and eventual death. At necropsy, the patient was found to have purulent meningitis focused in the lumbar region from which cultures grew E. coli (Fig. 2). The large hernia defect is shown in Figure 3. No direct communication of the wound to the spinal column was identified. Microscopy revealed perineural inflammation along lumbar nerve roots. DISCUSSIONWood and colleagues describe three types of traumatic abdominal herniation after trauma. Small lower quadrant herniation as a result of handlebar type injuries, rare intraabdominal hernias resulting from peritoneal rents, and large muscular tears or avulsions as a sequelae of motor vehicle collisions. 1 Lumbar hernias are rare and those because of trauma are of the secondary acquired type. Along with infection and surgical causes, these acquired hernias represent 25% of all lumbar hernias. 2 Previous authors have postulated that this may represent a form of seat belt injury, especially in obese patients, subject to deceleration type forces to the abdominal wall musculature with a high riding seat belt and subsequent muscl...

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“…Their natural history is to gradually increase in size, causing discomfort, occasionally in the distribution of the sciatic nerve. Up to 25% may incarcerate and up to 18% may strangulate if not repaired [1,7,8].…”

Section: Discussionmentioning

confidence: 99%

Traumatic Lumbar Hernias: Difficulty with Diagnosis and Repair

Lukan¹,

Franklin²,

Spain³

et al. 2000

European Journal of Trauma

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Infrequently encountered, the traumatic lumbar hernia presents a challenge to the surgeon both in diagnosis and management. Repair is often complicated by a lack of viable fascia and a high incidence of associated injuries. The following review considers the natural history of lumbar hernias and their etiologies. Subsequently, the role of computed tomography (CT) in diagnosis is discussed. Finally, the multiple techniques of repair are presented, along with a discussion of the role of laparoscopy.Two case reports of traumatic lumbar hernias are presented, followed by a review of the literature and discussion. The case reports include a 36-year-old bicyclist who was thrown into a fixed roadway object and a 44-year-old victim of a side impact motor vehicle crash.The 36-year-old bicyclist underwent open repair with polytetrafluoroethylene (PTFE) and has done well at 7-month follow-up. The 44-year-old victim of a motor vehicle crash underwent open primary repair and has done well at 36-month follow-up.Traumatic lumbar hernias require a high index of suspicion in order to avoid the potential for incarceration and missed associated injuries. CT is helpful in making this diagnosis. Principles of hernia repair including freedom from tension and avoidance of compromised fascia are vital. Additionally, a thorough evaluation for associated injuries is paramount. Mesh should be used liberally and laparoscopy offers some advantage in the hands of the experienced.

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Traumatic Lumbar Hernia Due to Seat Belt Injury

Cited by 32 publications

References 8 publications

A unique presentation and repair of a traumatic lumbar hernia

A unique presentation and repair of a traumatic lumbar hernia

Meningitis Complicating Traumatic Lumbar Herniation

Traumatic Lumbar Hernias: Difficulty with Diagnosis and Repair

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