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.
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.