Background Blunt traumatic abdominal wall hernias (TAWH) are uncommon injuries with variable presentation and unstandardized management. Few national systematic descriptive studies have been conducted about TAWH. We present a retrospective descriptive study utilizing the National Trauma Data Bank (NTDB) to better characterize risk factors associated with TAWH and management practices. Methods The NTDB (years 2016-2019) was examined for adult blunt trauma patients who had TAWH. Data included demographics, trauma-specific variables, management strategies, and outcome measures. Descriptive statistics were performed by univariate analysis. Results 2 871 367 adult blunt trauma patients were identified in the NTDB dataset. 206 had abdominal wall hernias (<.01%). Compared with the overall blunt trauma cohort, patients with TAWH had higher body mass index (BMI) and Injury Severity Scores (ISS), were more likely to be male, and had a higher mortality rate. 44 patients (21%) underwent operative management during their initial admission. Surgically managed patients were younger, had higher ISS and BMI, and were more likely to have concomitant intra-abdominal injuries. The few patients who had laparoscopic surgery had significantly higher BMI. Patients managed operatively had longer hospital and ICU lengths of stay and increased incidence of medical complications. Conclusions TAWH is an uncommon complication of blunt abdominal trauma, associated with higher BMI, ISS, and increased mortality. Initial operative management was pursued in 21% of cases, more often in younger, more severely injured patients with other intra-abdominal injuries. Evidence-based guidelines, based on multicenter prospective studies with longer follow-up, should be developed for management of these unique injuries.

Acute cholecystitis is one of the most common reasons for acute surgical intervention in the emergency setting [1]. Rarely, pathological examination of the surgical specimen reveals incidental gallbladder cancer and even more infrequently metastasis of gallbladder from a distant site. We present a case of a patient with a known history of inflammatory breast carcinoma, who presented with symptoms of right upper quadrant pain and jaundice and diagnostic work-up consistent with acute cholecystitis, subsequently found to have metastatic breast cancer to the liver and gallbladder.

Lumbar decompressive laminectomy for spinal stenosis can be performed using a less-invasive, unilateral approach with subperiosteal dissection and decompression by undermining the lamina from the ipsilateral to the contralateral side. A unilateral approach to bilateral decompression can be supplemented with interspinous instrumentation and facet fusion, a combined procedure that has not been studied before. The less-invasive technique appears to be as effective for lumbar stenosis as the traditional lumbar laminectomy. It also causes less blood loss and reduced operating time, and so may benefit patients who are elderly, medically frail, or with multiple comorbidities.Fifteen patients (eight females, seven males) underwent outpatient surgery by the author (HA) using this technique. These patients complained of progressive lower back pain associated with radicular pain exacerbated by prolonged standing or walking with improvement in flexed position of the lumbar spine with decreased walking distance ability. A one-level less-invasive lumbar laminectomy and foraminotomy with facet fusion and interspinous fixation were performed for spinal stenosis in conjunction with a Grade I degenerative spondylolisthesis. These patients all had a single-level facet fusion with bone graft material and local autograft. The approximate surgical time for each patient was between 50 and 80 minutes. The visual analog scale for pain (VAS) score decreased significantly after surgery; patients presented with preoperative VAS scores of 5-10/10 (mean 8.33/10). Postoperative VAS scores were 0-6/10 (mean 2/10), yielding a mean VAS improvement of 76% following surgery. Future analysis should be performed for evaluation of sustained VAS score, Oswestry Disability Index (ODI), Form 36 Health Survey Questionnaire (SF 36), and the Zurich Claudication Questionnaire (ZCQ).