Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.Blunt abdominal trauma may cause both crush and shearing effects on healthy abdominal wall and viscera [1]. Acute onset indirect inguinal hernia with testicular dislocation after blunt trauma is rarely reported [2], but, to our knowledge, a case resulting in complete obliteration of the inguinal canal with direct herniation of the abdominal viscera has not been documented.The inguinal canal extends from the anterior superior iliac spine to the pubic tubercle. A defect in the posterior wall results in a direct hernia. In our case, all boundaries of the inguinal canal including the floor, posterior, inferior, medial walls and deep and superficial rings were obliterated causing traumatic herniation of the terminal ileum and caecum beneath an attenuated external oblique aponeurosis.We describe the timely reconstruction of the abdominal wall in the inguinal region and the importance of the restoration of normal anatomy with definitive repair after resolution of swelling and haematoma.A 24 year old man was admitted to hospital following a road traffic accident after his motorcycle collided with a lorry. The speed of collision was 35 mph and abdominal injuries were sustained as a result of impact against the motorcycle handle bars.On arrival to the Emergency Department the patient was haemodynamically stable and fully conscious. Primary survey revealed a soft abdomen with tenderness, swelling and bruising in right groin and scrotum. There was no previous history of groin hernia.Secondary survey, plain X ray and CT scan confirmed a fracture dislocation of the right shoulder, open frac