Traumatic hepatic hernia formation following abdominal trauma: A case report.

Abstract

<h4>Rationale</h4>Abdominal trauma and hernia formation represent relatively common clinical entities. However, traumatic abdominal wall hernia resulting from abdominal injury, specifically involving hepatic protrusion through the abdominal wall, is sparsely documented in the literature. The rarity of such cases, often due to high-impact forces and unique shear mechanisms, makes them noteworthy for surgical documentation and review. Following diagnosis, abdominal wall hernias typically necessitate surgical intervention to reduce the herniated contents and reconstruct the compromised wall, often with mesh reinforcement. Left untreated, these hernias pose a risk of potentially serious complications such as incarceration, strangulation, or bowel ischemia. Therefore, prompt recognition and timely surgical repair are critical to prevent life-threatening sequelae and ensure optimal patient outcomes.<h4>Patient concerns</h4>A 57-year-old female patient presented 9 hours prior to admission following a bicycle collision, sustaining right flank trauma. Physical examination revealed a 6 × 7 cm subcutaneous ecchymosis at the impact site, and the patient experienced severe pain.<h4>Diagnoses</h4>Preoperative computed tomography and abdominal ultrasonography revealed focal protrusion of the right hepatic lobe through the abdominal wall. Intraoperative laparoscopic examination confirmed the diagnosis of hepatic herniation. The hernia was characterized by protrusion of liver segment V into the anterior abdominal wall, with dense adhesions to the abdominal wall.<h4>Interventions</h4>The patient underwent laparoscopic surgery, during which laparoscopic exploration confirmed the diagnosis of hepatic herniation. Subsequently, reduction of the herniated liver segment and surgical repair of the resulting abdominal wall defect were performed.<h4>Outcomes</h4>Postoperatively, the patient experienced marked reduction in abdominal pain. Follow-up computed tomography demonstrated restoration of normal hepatic anatomical architecture. Liver function tests and routine biochemistry panels revealed no significant abnormalities.<h4>Lessons</h4>Traumatic hepatic herniation represents an uncommon clinical entity, frequently leading to inadequate vigilance among clinicians regarding rare complications during routine management of abdominal trauma. Consequently, early and comprehensive utilization of imaging modalities, supplemented by minimally invasive diagnostic or therapeutic techniques when indicated, is essential to achieve precise diagnosis and management within a precision medicine framework.