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The definitions and historical diagnostic criteria proposed by different authors for diagnosis of TAWH in the English-language medical literature
Source publication
Traumatic abdominal wall hernia (TAWH) is an uncommon form of hernia caused by blunt traumatic disruption of the abdominal wall musculature/fascia and abdominal organ herniation. Diagnosis of TAWH is challenging and requires a high level of suspicion. This form of hernia seems to be underrepresented in the English-language medical literature. There...
Context in source publication
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Citations
... Avulsion is a speci c and rare type of injury in tra c accidents that involves the separation of tissues, such as muscle or bone. In the case of abdominal wall avulsion, there is an injury to the muscle that is usually accompanied by injuries to the hollow viscera or splenic lacerations, which usually requires emergency surgery [1][2][3][4][5][6][7][8][9] The indication for emergency or deferred surgery depends on several factors, including the severity of the injuries, the patient's condition, and the available resources. ...
Background
Seat belt syndrome (SBS) is a rare condition described as injuries sustained due to thoracic, abdominal, and pelvic compression in the context of traffic accidents. These injuries can range from minor skin abrasions to large lesions of internal organs and spinal cord involvement. Traumatic abdominal wall hernias (TAWH) are one of the injuries that can be associated with this condition.
Material and Methods
We present a review of our case series and the description of a unique case of a 21-year-old male with a high severity injury, with complete transection of all abdominal wall musculature secondary to SBS, with associated visceral injury. Emergency surgery required intestinal and sigmoid colon resection, as well as repair of the cava vein. After a long recovery period, a second-stage surgery was planned for abdominal wall reconstruction, with prehabilitation using botulinum toxin and pneumoperitoneum, as well as surgical planning with a CT scan with 3D reconstruction of the abdominal wall defect.
Results
A retrospective review was conducted of patients with SBS, of whom only 6 presented with TAWH. Five out of the 6 cases had associated intrabdominal visceral injuries, with emergency surgical treatment required. In the case of complete transection of the abdominal wall, a second surgery was required for scheduled abdominal wall reconstruction, involving transversus abdominis release and placement of double mesh.
Discussion
The therapeutic approach to traumatic abdominal wall injuries should be individualized to each patient, with a focus on addressing vital injuries first and considering abdominal wall reconstruction surgery at a subsequent stage. Utilizing CT scan with 3D reconstruction can serve as a valuable tool for preoperative planning in cases involving significant abdominal wall defects.
... It is seen in 1.5% of blunt abdominal trauma patients. Describe the mechanism by which it occurs as a result of disruption of the abdominal wall muscles and fascia due to increased intra-abdominal pressure [1,2]. This leads to the inability to maintain abdominal organs and other structures in their usual locations [3]. ...
... Most TAWH contained either a small bowel (69%) or a large bowel (36%), with 16% containing both [4] due to its mobility and being an unfixed peritoneal viscera, unlike the large colon (ascending and descending, which are secondarily retroperitoneal organs). These hernias are mostly associated with pelvic or chest injuries [1]. ...
... With percentages ranging from 30% to 60%, associated intraabdominal injuries such as intestine perforations, splenic ruptures, liver avulsions, or pelvic fractures are common [8]. Age, weak abdominal muscles, and pre-existing hernias are risk factors for TAWH [1]. Traumatic abdominal wall hernia (TAWH) can contain either the small bowel or the large bowel; a tiny number of TAWHs can contain both small and large bowels, though this is uncommon [8]. ...
Traumatic abdominal wall hernia (TAWH) is a rare type of hernia with an incidence of about <1.5%, resulting from blunt abdominal trauma, which leads to an increase in the intra-abdominal pressure and rupture in the abdominal musculature and fascia with herniation of the abdominal organs into the defect. Most TAWH contained either a small bowel (69%) or a large bowel (36%), with 16% containing both. This condition is often not present as an isolated case, as 30% to 60% of the cases are accompanied by other intra-abdominal injuries. The typical manner of presentation is a tender subcutaneous swelling across the abdomen wall with overlaying bruising and ecchymosis. The radiological investigative modality of CT scan has the highest index of diagnosing accompanied intra-abdominal visceral injuries. We present a rare case of a 23-year-old male patient diagnosed with TAWH containing both small bowel and sigmoid colon associated with psoas hematoma caused by a seat belt postroad traffic accident (RTA).
... The prevalence of hernia in patients with blunt trauma is approximately 1% [2][3][4]. Since no definitive diagnostic criteria or official classification for TAWH currently exist [2,5], the ideal timing and course of treatment are subject to debate. In this particular study, we present a case of TAWH and our surgical approach. ...
Traumatic abdominal wall hernia (TAWH) following blunt injury is a rare clinical entity, induced by traumatic disruption of the abdominal wall's muscle and fascia, alongside abdominal organ herniation. A thorough clinical examination and a high level of suspicion are necessary for the diagnosis. We present the case of a 45-year-old individual who presented to the surgical outpatient clinic with a left lateral bulge in his belly caused by a mountaineering accident. After obtaining a thorough history of the mechanism of injury and clinical assessment, abdominal ultrasonography and computed tomography (CT) scan revealed a significant traumatic left lateral abdominal wall hernia. The patient subsequently underwent an open surgical mesh repair, followed by anatomical and functional restoration of the muscular deficit over the mesh, with an uneventful postoperative course. TAWH constitutes a diagnostic challenge, and in many cases remains untreated for long periods of time. Considering that TAWH occurs in less than 1% of all blunt abdominal trauma, many surgeons are unaware of this rare manifestation. Here we suggest that elective surgery with an open, tension-free polypropylene mesh repair appears to be an appropriate therapeutic option.
... This series of 47 patients with TAWH had a similar incidence (0.5%), recurrence rate (23.3%) and wound complication (10%) compared to the literature. 3,4,6,9,10 This series' recurrence rate is toward the higher end of the 7.3%-26.7% range described in the literature, but has the advantage of diligent follow up of 97% of operative cases. ...
Background:
Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma, usually in the setting of multitrauma, with little consensus or guidelines for management. We present a case series of patients with traumatic herniae over a 9-year period and a suggested management algorithm.
Method:
Retrospective review of all patients with TAWH from 1st January 2011 to 31st December 2019 at a Level 1 adult Major Trauma Centre. Clinical presentation, surgical intervention and complications and recurrence were analysed.
Results:
Forty-seven patients were found to have TAWH, 0.5% of all major trauma admissions. Thirty (63.8%) were repaired, 12 acutely, 11 semi-acute and 7 delayed. All but 1 (fall>3 m) were transport associated, with a median Injury Severity Score (ISS) of 29. Follow-up data for operative cases were available for all but one (97%). Seven (23.3%) cases had a recurrence, more common in the acute repair group (33.3%) compared to semi-acute (18.2%), and elective group (14.3%).
Conclusion:
TAWH is a rare but potentially serious consequence of blunt abdominal trauma. This series has favoured earlier repair for anterior TAWH, or all those undergoing a laparotomy for other reasons, and elective repair for lumbar or lateral TAWH that do not require a laparotomy for other conditions. We present our preferred algorithm for management, accepting that there are many available strategies in this heterogeneous group of injuries. Loss of follow up and recurrence are a concern, and clinicians are encouraged to develop processes to ensure that TAWH are not a 'forgotten hernia'.
... Reconstruction of organ injuries and definitive abdominal wall closure needs a planned second-look surgery [7]. In case of contamination, the primary reconstruction or implantation of a biological mesh is theoretically possible [8]. In practice, however, experience has shown that a cosmetically and functionally good result is more likely to be achieved with a multi-stage procedure. ...
... 3 Approximately 140 cases have been published in the literature since the first reported case in 1906. 4 The current case is unique due to the presence of a TAWH coexisting within an MLL, as well as the innovative use of a dermal autograft to repair the hernia. There are few reported cases of MLL-associated TAWHs in the literature, and likewise, a paucity of management or treatment options described. ...
Morel-Lavallée lesions and traumatic abdominal wall hernias seldom present together and have no standardized guidelines for treatment. We present a unique case of a traumatic abdominal wall hernia present within a patient’s abdominal Morel-Lavallée lesion, which was reduced and repaired with a dermal autograft. This is a novel approach to repairing a rare and unusual injury. The literature suggests that tension-free repairs with mesh should be used on delayed repairs of traumatic abdominal wall hernias. However, some advocate for primary repairs due to an up to 50% increased risk of wound infection in these injuries, even without the use of mesh. Although infection rates with the use of biologic mesh (acellular dermal matrices) in a contaminated field are lower than that of synthetic mesh, infections still occur and tend to be higher in repairs without mesh. The lack of foreign material and innate immunogenicity of the patient’s own dermis may theoretically decrease the risk of infection compared with other commercially-available and biologically-derived products. The patient is a 47-year-old woman who was in a motor vehicle accident with prolonged extrication time. She was hospitalized for approximately 6 months due to extensive injuries, but had no further complications from her Morel-Lavallée lesion or repair of her traumatic abdominal wall hernia with her own dermis.
... TAWHs ultimately result from blunt trauma disrupting the abdominal wall musculature and fascia. The diagnostic criteria and, more importantly, appropriate management of TAWH have yet to be well established [10]. The case presented here identifies valuable approaches to complex abdominal wall reconstruction for TAWH with three particular areas of interest: (1) preoperative Botox injections, (2) operative use of mesh versus primary repair in contaminated fields, and (3) postoperative PT and patient positioning. ...
... The relative benefits of mesh include repairing defects too large for primary closure and less chance for recurrence; however, mesh has historically been reported as an absolute contraindication in peritoneal contamination with higher infection rates [9,13,14]. Some have begun to question this contraindication and instead now advocate for the use of biologic meshes as safe alternatives in the trauma setting [10,15]. Recent publications have even suggested that synthetic meshes may provide similar outcomes in both contaminated and clean repairs [16]. ...
Seat belt syndrome (SBS) represents all injury profiles associated with seat belt injuries and motor vehicle crashes (MVCs). Seat belt syndrome classically presents with a superficial seat belt sign that may signify deeper intra-abdominal and/or spinal involvement. The amount of force transmitted from the restraint to the passenger ultimately dictates the amount and severity of the injury. We present a unique case of a 59-year-old female involved in a motor vehicle crash with multiple traumatic injuries, including seat belt syndrome, abdominal wall transection, and bowel injuries. She later had reconstruction of her traumatic abdominal wall hernias (TAWHs). Three unique approaches were used in the management of her traumatic abdominal wall hernias: (1) preoperative Botulinum toxin (Botox) injections, (2) operative use of biologic and bioabsorbable meshes in contaminated fields, and (3) postoperative physical therapy and body positioning. The patient did not experience any recurrence of these hernias after her abdominal wall reconstruction and remains alive at the time this case was written. The diagnostic criteria and surgical management of traumatic abdominal wall hernias have yet to be established, and the case presented here provides approaches that should serve as future areas for study.
... Traumatic hernias are known to occur after both blunt and penetrating mechanisms and are associated with significant concomitant injury risk. 1,2 Traumatic disruptions of the abdominal wall, diaphragm, and chest wall, while well known, are generally considered rarer findings across a spectrum of all injury types and potentials. The incidence of each traumatic hernia occurrence is varied, and ideal management efforts continue to be debated. ...
... In emergency settings, an increased risk of infection may limit the repair to the use of biologic mesh, but if stability permits a delayed repair, synthetic mesh application has shown greater long-term durability. 2 Diaphragmatic rupture with abdominal organ herniation was first described in 1541 by Sennertus. 3 According to Testini et al, roughly 5% of trauma admissions are associated with TDH. 3 The incidence of diaphragm injuries is higher in penetrating trauma than in blunt trauma, at a rate of 10%-19% compared with 5% and is most commonly found on the left side (>80%). ...
... The second point concerns the ideal timing of hernia repair. Repair should be delayed in unstable patients (4). The last point concerns how to repair the hernia: whether to perform tissue or mesh repairs. ...
The prevalence of traumatic abdominal wall hernias (TAWHs) after blunt trauma is approximately 1%. When TAWHs are accompanied by the Morel-Lavallée lesion (MLL), a closed traumatic soft tissue degloving injury, they become susceptible to severe soft tissue infection which requires challengeable treatments. However, there are no published guidelines regarding the optimal management strategy at present. Herein, we describe the successful treatment for a TAWH with MLL in the anterior lower abdomen of a 66-year-old woman who sustained seatbelt-related injury following a traffic accident as a driver.
... Delayed traumatic bladder rupture is rare, and only five cases have been previously reported. [19,20] Three patients needed cystogastrostomy for pseudocyst of pancreas secondary to trauma. Two patients were referred with complications of duodenal perforation repair. ...
... Pediatric traumatic hernias are also unique because of the absence of internal injuries, and this was true for both our cases. [19] Four of our patients had hospital stay more than a month for their injuries requiring intensive care unit (ICU) stay and ventilation. In spite of extensive injuries, prolonged hospital stay, and multiple surgeries, children show remarkable resilience and survival. ...
Aim: The aim is to prospectively study 125 trauma patients admitted in the pediatric surgery ward in our institute.
Materials and Methods: Pediatric patients admitted in the ward after initial resuscitation in the triage room were included. Isolated neurosurgical and orthopedic injuries were excluded. X-ray cervical spine, hip, and chest and a focused assessment with sonography in trauma ultrasound were done for all patients. Computed tomography of the abdomen or chest was done where relevant. Injury profile and surgical intervention when needed were analyzed.
Results: Road traffic accidents and fall from height caused 73.6% of the injuries. School-going children were most commonly affected (60.8%). Distinctive injuries were noted such as abdominal wall hernias and delayed bladder perforation. All solid organ injury irrespective of grade treated conservatively. Forty percent of the children required surgical intervention. Five patients after laparotomy were found to have surgical conditions unrelated to trauma, whereas another 14 required delayed surgery. Five patients had injuries secondary to sexual abuse. All except two patients were discharged in a satisfactory condition and are doing well in the follow-up.
Conclusion: In spite of extensive injuries and the need for multiple surgeries, children with trauma have a good prognosis. Close observation during admission and also in follow-up are essential, as many patients may require delayed surgery ≥1 week from injury.
