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Acute traumatic abdominal wall herniation with evisceration
  1. Michael G Noujaim1,
  2. Jon D Dorfman2,
  3. Rachelle N Damle3
  1. 1University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Division of Trauma and Critical Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  3. 3Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Jon D Dorfman; jon.dorfman{at}umassmemorial.org

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A 43-year-old woman was the driver in a car crash versus a tree. After a prolonged extrication, she was taken to a local community hospital. Her injuries on clinical examination included an abdominal wall defect with small bowel evisceration and multiple orthopedic extremity injuries. She was intubated at the community hospital for altered mental status. The patient was then sent by air transport to our level I trauma center for further management. On arrival at the trauma bay, 3 hours after the injury, her pulse was 125 bpm and her blood pressure was 100/56 mm Hg. Her Glasgow Coma Scale was 3 T during the initial trauma bay assessment. Physical examination was notable for a left lower quadrant laceration that revealed an eviscerated small bowel.

What would you do?

  1. Perform abdominal imaging and close the defect if no intra-abdominal injury is detected?

  2. Proceed to the operating room (OR) for prompt exploratory laparotomy and surgical repair with or without mesh?

  3. Proceed to the OR for exploratory laparotomy and component separation repair of the abdominal wall?

What we did and why

Correct answer: B

CT scans of the head, cervical spine, chest, abdomen and pelvis (figure 1) were performed to determine if intracranial hemorrhage, aortic injury or cervical and thoracolumbar …

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