Traumatic inguinal hernia: An uncommonly reported entity

Abstract

Traumatic abdominal wall herniation, especially of the groin region, is a rare condition and typically results from a high-energy trauma to the abdominal wall. We report a fatal case of a road-traffic collision involving a young male motorcyclist who collided with a speeding lorry. The victim sustained multiple injuries over the chest and abdomen, with traumatic inguinal herniation causing gross distension of the scrotum. At autopsy, multiple lacerations of thoracic and abdominal organs were seen, along with traumatic disruption of the right inguinal canal. The contused terminal ileum was present in the scrotal sac. A literature search has revealed a limited number of reported cases of gross inguinal herniation following thoracoabdominal trauma. In cases of high-energy trauma to the thoraco-abdominal region with unilateral or bilateral distension of the scrotum, the possibility of herniation of the abdominal contents into the scrotal sac should be considered by the forensic pathologist.

Re: ‘Traumatic inguinal hernia: An uncommonly reported entity’

“…The first phase causes avulsion and laceration of the soft tissues and opening of the ‘passage’ – the inguinal canal – while the second phase includes a rise in abdominal pressure, which leads to organ displacement and herniation. Thus, we believe that it is not high-velocity trauma induced by a speeding lorry that caused the traumatic herniation in the case presented by Jadav et al., 1 but rather the two-phase mechanism: first, side-on collision, and second, running over.…”

“…1 According to the authors, a sudden increase in intra-abdominal pressure, along with the shearing effect on the abdominal muscle and fascia in this high-velocity trauma to the thoraco-abdominal region, should be considered as the primary aetiological mechanism in the development of traumatic hernia in this case. 1…”

“…It is very probable that traumatic herniation through the inguinal canal, such as in the case presented by Jadav et al., 1 is a two-phase injury. The first phase causes avulsion and laceration of the soft tissues and opening of the ‘passage’ – the inguinal canal – while the second phase includes a rise in abdominal pressure, which leads to organ displacement and herniation.…”

“…entitled ‘Traumatic inguinal hernia: An uncommonly reported entity’, which describes a fatal case of traumatic inguinal herniation of the terminal ileum into the scrotal sac in a 20-year-old male motorcyclist after a side-on collision and subsequent run over by a speeding lorry. 1 There was complete disruption of all of the boundaries of the inguinal canal, including deep and superficial rings, causing traumatic herniation of 90 cm of the terminal ileum into the scrotal sac. 1 According to the authors, a sudden increase in intra-abdominal pressure, along with the shearing effect on the abdominal muscle and fascia in this high-velocity trauma to the thoraco-abdominal region, should be considered as the primary aetiological mechanism in the development of traumatic hernia in this case.…”

“…1 There was complete disruption of all of the boundaries of the inguinal canal, including deep and superficial rings, causing traumatic herniation of 90 cm of the terminal ileum into the scrotal sac. 1 According to the authors, a sudden increase in intra-abdominal pressure, along with the shearing effect on the abdominal muscle and fascia in this high-velocity trauma to the thoraco-abdominal region, should be considered as the primary aetiological mechanism in the development of traumatic hernia in this case. 1…”