Traumatic Abdominal Hernia – Laparoscopic Reduction and Repair by IPOM-Plus
A 60 year old male, alcoholic patient with hypertension sustained an injury to the right upper abdomen when he tripped and fell laterally on a parapet wall. He was presented to the ER with a tender boggy swelling in the right hypochondrium with tachycardia and normal blood pressure.
Diagnosis And Treatment
MDCT the investigation of choice, which diagnosed an enterocoel with mesentric stranding and dilated bowel with a 6x 4 cm defect, fracture right 7,8, and 9 ribs and old healed left 8&9 ribs no pneumothorax or hemothorax.
MDCT is also helpful in excluding other associated intra-abdominal injuries, which determines our approach to manage open vs laparoscopic and also mesh vs no mesh repair. Recurrence with no mesh is 30%. Most of these are open surgeries. The recurrence after open mesh is 10% and after Laparoscopic mesh repair 7.5%. Apart from recurrence, the other concerns are fluid collection. Mesh related complications like shrinkage, adhesions, bowel adhesions and fistulisation are uncommon if proper mesh are used and fixed safely.
We managed this patient laparoscopically IPOM-Plus with reduction of herniated small bowel, closure of the defect and placing a dual mesh.
Intraperitoneal Onlay Mesh
Sagittal CT scan showing Hernia
Dilated loop of bowel