Traumatic Abdominal Wall Hernia: Early or Delayed Repair?

Abstract

Traumatic abdominal wall hernia after blunt trauma is a rare entity. They can easily be overlooked in patients who have multiple trauma, as its signs and symptoms may be variable due to the presence of multiple injuries. Imaging with computed tomography or ultrasound confirms the diagnosis as well as identifying any associated injuries. Although surgery is the standard treatment for traumatic abdominal wall hernias, there is no consensus on the early or late repair of the defect. Some authors recommend early surgical intervention in order to avoid the risk of intra-abdominal organ injury, incarceration, and strangulation. In this study, we report our experience in three cases, which did not involve emergency surgery. Long-term outcome is successful. Elective hernia repair may be safe and feasible in stable patients.

Handlebar Hernia with Triple Herniation and Perforation: A Case Report and Literature Review

“…The traumatic abdominal wall hernia usually has an intact overlying skin, which can masquerade an underlying defect and can be missed at the time of presentation sometimes presenting at a later stage or can prove to be fatal. Commonly the traumatic abdominal wall hernia due to handlebar injury are found in the infraumbilical region usually lateral to rectus muscle and a very few in the supraumbilical region [ 9 ].…”

Traumatic abdominal wall hernia secondary to seatbelt injury: a case successfully managed by delayed surgical mesh repair and complicated by intervening pregnancy

“…Some authors recommend early surgical repair to avoid the risk of intra-abdominal organ injury, incarceration and strangulation; with the reported risk of incarceration and/or strangulation ranging from <10 to >25% 5. Another report, however, suggests undergoing a procedure on initial presentation to be associated with a higher number of injuries and a higher injury-severity score 6.…”

Abdominal herniation associated with bullhorn injury as a separate entity from traumatic abdominal wall hernias

“…There has been an ongoing debate regarding the timing of repair, that is, early versus delayed repair of TAWHs. [ 28 29 30 ] Early repair has been the most commonly reported entity in literature, and its proponents say that with delayed repair defects may enlarge, muscle may undergo disuse atrophy, primary approximation may become difficult and other injuries may be missed. However, more recently, delayed repairs of TAWHs in stable patients have been reported with optimal outcomes.…”

“…However, more recently, delayed repairs of TAWHs in stable patients have been reported with optimal outcomes. [ 28 29 31 ] Singh et al have described a clean hernial defect with no tissue edema or inflammation peroperatively on delayed repair, due to which laparoscopic anatomic repair of defect was done very easily. [ 2 ] This fact is further reinforced by the case reported by Singh et al , as the authors did not repair the hernial defect at initial operation even though they started the operation by an incision over the defect and then converted it into a midline laparotomy.…”