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 50-year-old male presented a day after sustaining blunt abdominal injury by a bull horn to the right side of his abdomen. He presented with right lower abdominal swelling. He was hemodynamically stable with a pulse of 82/min and a BP of 130/90 mm Hg. A chest X-ray diagnosed a right simple pneumothorax for which a chest tube was inserted. FAST exam was normal, but contrast CT revealed herniation of bowel through a defect in the anterior abdominal wall []. 3 days after injury, an exploratory laparotomy was done which showed no associated intraperitoneal injury and the hernia was reduced, and the defect reinforced with a mesh. The patient was discharged on postoperative day 7.