Abstract
Background
Traumatic abdominal wall hernias (TAWH) have been recognized for more than a century since they were first reported by Selby (JAMA 47:1485–1486, 1906). They continue to be a rare diagnosis, encountered in approximately 1 % blunt trauma admissions. The present study is a 10-year retrospective review of patients presenting with TAWH to a State Major Trauma Unit in Western Australia. We hypothesized that the timing of the repair of TAWH was dependent on the severity of the abdominal wall injury, as well as associated injuries, and in turn, this may affect patient outcomes.
Materials and methods
The Trauma Registry at Royal Perth Hospital (the only Level I Trauma Centre for adults in Western Australia) was scrutinized for TAWH, between 2003 and 2013. The injuries were graded by the classification system of Dennis et al. (Am J Surg 197:413–417, 2009) .Patients with TAWH following penetrating trauma were excluded.
Results
During the study period, 44 patients were diagnosed to have TAWH accounting for 0.08 % of admissions. Thirty (68 %) of the patients were male and the median age was 36 years (IQR 24–54). The median BMI was between 25 and 30. The majority of the patients sustained trauma secondary to motor vehicle crashes and the commonest associated injury was a pelvic fracture. Grades 3 and 4 injuries were found to have an association with a pelvic fracture (p < 0.001). No association was seen in the present study between seat belt use and the development of TAWH or between the location of TAWH and seat belt pattern. The median time of diagnosis of TAWH following arrival to hospital was 18 hours while the median time of surgery from diagnosis was 15.5 hours. Forty-one (93 %) of the patients underwent surgery. Of these, 8 (20 %) were emergent due to a simultaneous bowel perforation and another five had primary mesh repairs. Three of the patients suffered superficial complications (7.5 %) and there were 3 (7 %) recurrences at a mean time of 7.25 months from the first repair. The follow-up period ranged from 1 to 51 months with an average time of 16 months.
Conclusion
This series is the largest single institution study conducted on TAWH to date. Despite its retrospective nature and small numbers, it has generated some important questions. A larger prospective study with a longer follow-up period is required to generate reliable treatment algorithms as well as to standardize the management of TAWH.
Similar content being viewed by others
References
Selby RD (1906) Direct abdominal hernia of traumatic origin. JAMA 47:1485–1486
Liasis L, Tierris I, Lazarioti F et al (2013) Traumatic abdominal wall hernia: is the treatment strategy a real problem? J Trauma Acute Care Surg 74(4):1156–1162
Brenneman FD, Boulanger BR, Antonyshyn O (1995) Surgical management of abdominal wall disruption after blunt trauma. J Trauma 39(3):539–544
Honaker D, Green J (2013) Blunt traumatic abdominal wall hernias: associated injuries and optimal timing and method of repair. J Trauma Acute Care Surg 77(5):701–704
Netto FACS, Hamilton P, Rizoli SB et al (2006) Traumatic abdominal wall hernia: epidemiology and clinical implications. J Trauma 61(5):1058–1061
Dennis RW, Marshal A, Deshmukh H et al (2009) Abdominal wall injuries occurring after blunt trauma: incidence and grading system. Am J Surg 197:413–417
Ganchi PA, Orgill DP (1996) Autopenetrating hernia: a novel form of traumatic abdominal wall hernia-case report and review of the literature. J Trauma 41(6):1064–1066
Wagner AC (1979) Disruption of abdominal wall musculature: unusual feature of seat belt syndrome. Am J Roentgenol 133:753–754
Kumar A, Hazrah P, Bal S, Seth A, Parshad R (2004) Traumatic abdominal wall hernia: a reappraisal. Hernia 8:277–280
Gutteridge I, Towsey K, Pollard C (2014) Traumatic abdominal wall herniation: case series review and discussion. ANZ J Surg 84:160–165
Forman J, Lopez-Valdes FJ, Lessley D et al (2009) The effect of obesity on the restraint of automobile occupants. Ann Adv Automot Med 53:25–40
Lane CT, Cohen AJ, Cinat ME (2003) Management of traumatic abdominal wall hernia. Am Surg 63(1):73–76
Singal R, Gupta R, Mittal A et al (2012) Delayed presentation of the traumatic abdominal wall hernia; dilemma in the management: review of literature. Indian J Surg 74(2):149–156
Gupta S, Dalal U, Sharma R et al (2011) Traumatic abdominal wall hernia. Ulus Travma Acil Cer 17(6):493–496
Yadav S, Jain SK, Arora JK et al (2013) Traumatic abdominal wall hernia delayed repair: advantageous or Taxing. Int J Surg Case Rep 4(1):36–39
Singh R, Kaushik R, Attri AK (2004) Traumatic abdominal wall hernia. Younsei Med J 45(3):552–554
Bender JS, Dennis RW, Albrecht RM (2008) Traumatic flank hernias: acute and chronic management. Am J Surg 195:414–417
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pardhan, A., Mazahir, S., Rao, S. et al. Blunt Traumatic Abdominal Wall Hernias: A Surgeon’s Dilemma. World J Surg 40, 231–235 (2016). https://doi.org/10.1007/s00268-015-3256-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-015-3256-5