Case report of traumatic interparietal spigelian hernia in a toddler: an unusual presentation

Abstract

Traumatic interparietal hernias are rare injuries of the abdominal wall muscle planes following blunt trauma, with an incidence of about 0.1% in children. When they occur through the spigelian fascia, they form a traumatic interparietal spigelian hernia (TISH). The junction of the semilunar and arcuate lines is the weakest part of the spigelian fascia and accounts for most spigelian hernias. We report a 19-month-old boy who developed an anterolateral thoracoabdominal swelling and respiratory distress after a pedestrian–vehicle collision. Examination showed asymmetry of the chest wall with a pyriform swelling from the left hypochondrium to the left hemithorax. Chest radiograph demonstrated hyperlucent bowel patterns in the left anterolateral chest wall with intact diaphragmatic domes. After resuscitation, he underwent laparotomy, which revealed a 3 cm defect at the linea semilunaris with transverse colon herniation. The defect was repaired primarily. Recovery was uneventful. Early recognition of TISH is vital for timely intervention. Aortic aneurysms (VAAs) are rare vascular lesions associated with a substantial risk of rupture and high mortality. Splenic artery aneurysms (SAAs) are the most common and best studied, with relatively well-established risk factors and management strategies. In contrast, uncommon VAAs arising from the hepatic, celiac, superior mesenteric, gastroduodenal, pancreaticoduodenal, gastroepiploic, gastric, jejunal, ileal, colic, and inferior mesenteric arteries are exceedingly rare, and their natural history and rupture predictors remain poorly defined. Rupture has been reported at small diameters, challenging size-based thresholds derived largely from SAA data.