Blunt traumatic abdominal wall hernias: Associated injuries and optimal timing and method of repair

Abstract

Background: Traumatic abdominal wall hernias resulting from blunt trauma can be difficult to identify and manage. Few reported series exist in the literature. This study aimed to identify strategies for traumatic hernia management, characterize associated injuries, and determine outcomes of this patient population.

Methods: Patients who sustained a traumatic abdominal wall hernia secondary to blunt trauma were reviewed during a 5-year period. Demographic data, Injury Severity Score (ISS), associated injuries, type of repair, and durability of repair were examined, and descriptive statistics were calculated. p < 0.05 was considered significant.

Results: Thirty-eight patients were identified. ISS ranged from 1 to 66, with a mean of 19.8. Of these patients, 34 had associated injuries; the most common organs injured were the small bowel followed by the colon. The average number of concomitant abdominal and pelvic injuries per patient was 2.4. Mortality rate was 5.3% (2 of 38). Twenty-seven patients (71%) underwent immediate repair, three (7.9%) underwent delayed repair, and eight did not have their hernias repaired. Of the patients who underwent repair, two developed a recurrence (6.7%); both were flank hernias. One of these patients had a biologic mesh placed, and one was repaired primarily. Mesh repair was performed in 11 patients. Four had a synthetic mesh placed, with three (75%) performed in a delayed fashion after discharge from their initial hospitalization. Nineteen (50%) underwent primary repair at the time of initial presentation.

Conclusion: Associated abdominal and pelvic injuries are extremely common, and physicians should be diligent in searching for these injuries. Our data support the use of a synthetic mesh in delayed fashion when feasible. However, because of the low number of patients in this study, a definitive recommendation cannot be made.

Level of evidence: Epidemiologic study, level III. Therapeutic study, level IV.