An 82-year-old man presented to the ED with abdominal pain. While walking in his yard he had fallen onto a two-inch-diameter piece of steel rebar. EMS reported seeing a locally expanding area while the patient was being prepared for transport. He had no history of surgery or swelling in the affected region.
On examination the patient was normotensive without signs of shock. He had a small abrasion on his head but did not lose consciousness, showed no altered mental status, and did not have a headache or focal neurological signs. His abdomen revealed a well-circumscribed area where the rebar impacted, with an abrasion extending inferiorly. His abdomen was soft, tender only over the abrasion, with no rebound or guarding or abnormal bowel sounds. There were no other positive exam findings.
Labwork, including CBC and creatinine, was normal. An abdominal CT with
contrast showed a left lateral abdominal wall hernia. The hernia had a
four-centimeter neck and contained colon without findings of
obstruction, perforation, or significant hematoma.
The patient was referred to the trauma service and underwent an urgent abdominal exploration and repair of the traumatic hernia. A small serosal hematoma was discovered on the descending colon, which was unroofed and then repaired after showing no evidence of a full thickness injury. The hernia was reduced and the abdominal wall defect was repaired without mesh.
The patient developed a post-operative ileus and paroxysmal atrial fibrillation but was discharged home in stable condition twelve days later.
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