摘要
由自行车手把直接创伤导致的创伤性腹壁膨出疝(TAWH)较少见。目前只有21例手把创伤性疝的报道。一个11岁男童从其自行车上摔下来并且车把撞击到其右下腹部位。后来被送到急诊室。患者的生命体征和最初的实验室检查都正常。体格检查表明在右下皮肤表面有瘀斑,软组织肿胀并且触诊有压痛。CT表明肠管环形突出,通过腹壁缺损进入腹壁皮下间隙。外科手术探查发现缺损贯穿整个腹壁包括筋膜、肌层和腹膜,肠管通过缺损突出到皮下间隙。对所有缺损逐层修补且术后男童的病情平稳。作者建议在临床中对所有创伤性腹壁损伤要高度怀疑TAWH的存在。关键的治疗是外科手术检查时对所有腹壁组织层进行初次修补。
Traumatic abdominal wall herniation (TAWH) caused by direct trauma from bicycle handlebars are rare. There are only 21 reported cases of handlebar hernias. An 11 -year-old boy presented to the emergency room soon after falling from his bicycle and hitting his right lower quadrant on the handlebars. The patient's vital signs and initial laboratory studies were normal. Physical exam showed a soft tissue bulge in the right lower quadrant with superficial ecchymosis and tenderness to palpation. Computed tomography showed intestinal loops protruding through a defect in the abdominal wall into the subcutaneous space. Surgical exploration found a defect throughout his entire abdominal wall including the fascia, muscular layers, and peritoneum, with bowel protruding into the subcutaneous space. The defect was repaired in layers, and the child's postoperative course was unevenful. The authors recommend a high level of clinical suspicion for TAWH in all patients with traumatic abdominal wall injuries. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.
