A nearly 7-year-old boy, with no relevant past history, visited our emergency department with abdominal pain and swelling after a fall from his bike. Whilst riding his bike, he had fallen and his abdomen had landed on the handlebar. Immediately after the accident, his mother noticed a swelling where the handlebar had hit his abdomen. They visited the general practitioner on call who subsequently sent him to our emergency department. Apart from pain, he had no other complaints. On physical examination, he seemed to be not ill and he was haemodynamically stable. Examination of the abdomen showed a circular contusion of the skin several centimetres below the umbilicus just on the right of the midline (Fig. ). On palpation, a clear defect of the rectus fascia could be felt. There were no signs of peritonitis suggesting an enteral lesion. He was admitted for observation and discharged the following morning. He was scheduled for surgery 1 week later. During the operation, a skin-line incision was performed over the fascia defect, revealing a rupture of the musculus rectus abdominis, as well as a total rupture of the right rectus fascia (Fig. ). The rectus sheath was closed with a continuous Vicryl suture. The muscle defect was approximated with interrupted Vicryl sutures. The skin was closed intracutaneously. He was discharged the following day and recovered uneventfully.
A 6-year-old boy was admitted to the emergency department 3 days after a bicycle accident. The handlebar of his bicycle traumatized his abdominal wall above the left iliac crest. Twelve hours before the admission he noticed a palpable mass and a minor bruising to this specific point (Fig. ).\nThe physical examination revealed the presence of a painless swelling measuring 8 × 3 cm2 and did not reveal any pathological sign from the abdomen. The swelling was reducible, disappeared in supine position and increased by coughing. The diagnosis of a HH was suspected and confirmed by ultrasound that showed the disruption of internal and external oblique and transverse muscle (6 × 1.5 cm2) and the projection of omentum through the hernia without other associated internal organ injuries (Fig. ). The hematological and biochemical tests were normal. We suggested the admission of the child in our clinic for further clinical monitoring but the parents denied.\nThe reassessment after 2 weeks of rest at home showed an obvious size reduction of the hernia. Because of the significant size difference a MRI evaluation was decided, that confirmed that the disruption size was 3 × 0.7 cm2. In the follow up a month later, the hernia was no longer palpable and the ultrasonography identified a defect <2 mm without herniation.