Delayed repair for traumatic abdominal wall hernia: is it safe?

Abstract

Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed repair. A single case study can hardly be considered as a basis for profound changes in the management of post traumatic hernias. However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient.

Traumatic abdominal wall herniation: case series review and discussion

“…defined TAWH as the ‘herniation through disrupted musculature and fascia associated with trauma, without skin penetration, and no evidence of a prior hernia defect at the site of injury’ . Although TAWH has been a recognized complication for over a century, the methods and timing of repair are still debated. Mechanism of injury is usually high‐speed automobile accidents, impact with bicycle/motorcycle handlebars or blunt trauma via falls .…”

Traumatic Abdominal Wall Hernia: Early or Delayed Repair?

“…At the present, a widespread use of CT in the identification of possible intra-abdominal injuries in patients who were subject to blunt traumas paved the way for more frequent and earlier diagnosis of TAWHs. Now, almost 72 % of the cases are diagnosed at first admission [6,7,12,13]. If and when needed, contrast radiography such as barium studies, ultrasonography, and magnetic resonance imaging can also be performed.…”

A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach

“…Prosthetic mesh, in the absence of bowel compromise, can be used at the time of initial repair or in a delayed fashion when the patient's clinical status is optimized. 10 Laparoscopic placement of a mesh prosthesis allows for a tension-free repair, with secure bony fixation, without the morbidity associated with an open approach.…”