Objectives: Traumatic abdominal wall hernias (TLH) are relatively uncommon however the sheering force that results in fascial disruption could indicate an increased risk of visceral injury. The aim of our study was to evaluate whether the presence of a TLH was associated with intra-abdominal injury requiring emergent laparotomy.
Methods: The trauma registry was queried over a 10-year period (7/2012 - 7/2022) for adult patients with blunt thoracoabdominal trauma diagnosed with a TAWH. Those patients who were identified with a TLH and greater than 15 years of age were included in the study. Demographics, mechanism of injury, ISS, BMI, length of stay, TAWH size, type of TAWH repair and outcomes were analyzed.
Results: Overall, 38,749 trauma patients were admitted over the study period, of which 37 (0.09%) had a TLH. Patients were commonly male (n=20, 54%); the median age was 36 years (range 16–73 years) and a mean ISS of 22 ± 17 and AIS-abdomen = 2. Forty-percent had + seatbelt sign. The majority were left sided TLHs (n=33, 66%) with mean size 3 ± 2 cm. Sixteen patients (32%) went emergently to the operating room, the majority for perforated viscus (n=9, 18%) with 18 requiring bowel resection (36%). Mean ventilator day 7 ±15 days, with a mean ICU LOS 9 ±16 and mean hospital LOS 23 ± 31 days. A minority of TLHs (16%) were repaired at index operation, primary repair (10%), and mesh 18%. Two of the three deaths were directly related to head injury and the remaining from ARDS.
Conclusion: TLHs are associated with increased intra-abdominal injury requiring emergent laparotomy for other life-threatening injuries. Further investigation is needed to identify which seriously injured patients benefit from immediate or delayed repair of a TLH.
