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Management of traumatic abdominal wall hernia
Christopher T Lane1, Allen J Cohen, Marianne E Cinat
1Department of Surgery, University of California, Irvine Medical Center, Orange, California, USA.
The American Surgeon
|February 11, 2003
Summary
Traumatic abdominal wall hernias (TAWH) from high-energy impacts require exploratory surgery and primary repair. Avoid prosthetics due to high infection risk in these severe blunt trauma cases.
Area of Science:
- Trauma Surgery
- Abdominal Wall Reconstruction
- Emergency Medicine
Background:
- Traumatic abdominal wall hernia (TAWH) is classified by injury energy: low (small blunt object) or high (e.g., motor vehicle accidents).
- High-energy TAWH often presents with obscured physical findings due to associated abdominal trauma.
Observation:
- Six high-energy TAWH cases were treated, all confirmed by CT scan.
- Patients exhibited abdominal tenderness and skin ecchymosis/abrasions, complicating initial assessment.
- All patients had associated injuries necessitating open surgical repair.
Findings:
- Primary repair of abdominal wall defects was performed in all cases.
- Fifty percent of patients developed postoperative wound infections or abscesses.
- Literature review indicates low-energy TAWH lacks associated abdominal injuries.
Implications:
- Distinguishing between low- and high-energy TAWH is crucial for appropriate management.
- Low-energy TAWH can be managed with local exploration.
- High-energy TAWH mandates exploratory laparotomy, primary repair, and avoidance of prosthetics to minimize infection risk.