PMC3043450_01
Spiral CT scan of the abdomen and pelvis with oral and intravenous contrast. Open arrow points to free fluid tracking down the right side of the pelvis. Solid arrow points to disrupted right lower abdominal wall musculoaponeurotic layers; only skin covers the underlying bowel.
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F1
The CT scan revealed free fluid in the pelvis with disruption of the musculoaponeurotic layers of the right lower abdominal wall (Figure 1).
Intraoperative picture, as seen through the laparo-scope, of the traumatic abdominal wall hernia in the right lower abdomen.
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F2
Initial inspection revealed a small amount of blood within the pelvis that appeared to be coming from the right lower quadrant where bowel was incarcerated through a defect in the abdominal wall (Figure 2).
Cecum after delivery from the abdominal wall hernia. Note deserosalized area in center of picture.
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F3
Treitz to the ileocecal region. The hernia was reduced and contained the cecum that had a small serosal injury with surrounding contusion (Figure 3).
The elliptical peritoneal wall defect as seen from within the peritoneal cavity. Open arrow points to region of internal inguinal ring. Solid arrow points to round ligament.
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F4
The peritoneal defect was oriented perpendicular to the musculoaponeurotic defect exposing the round ligament as it left the internal ring (Figure 4).
Intraoperative picture demonstrating intraperitoneal placement of the Gore-texTM dual mesh. Mesh is anchored to the Cooper's ligament and the lateral abdominal wall using auto-suture tacks.
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F5
Surgical, Norwalk, CT) (Figure 5).