Traumatic abdominal wall hernia: A case report and literature review

Traumatic abdominal wall hernia is a rare but serious diagnosis resulting from blunt abdominal trauma. The clinical diagnosis is not usually straightforward and the hernia is often discovered at the time of the surgical exploration for intra-abdominal injuries or by imaging studies.

A 25-year-old obese, restraint, male patient was the victim of a high-speed road traffic accident. Among other injuries, he showed extensive skin maceration and bruising over the lower abdomen and flanks upon presentation, however he did not need any surgical intervention. Contrast-enhanced computed tomography scan of the abdomen and pelvis demonstrated extensive abdominal wall muscular disruption over both flanks with herniation of the right colon. Counselled to follow up in 4-6 weeks to have the hernia surgically repaired, he showed up after 8 months with a large muscular defect resulting in a large hernia containing small and large bowel loops.

The timing and type of the surgical repair of traumatic abdominal wall hernia depends upon the size of the hernia defect and the presence of associated intra-abdominal injuries. Delayed repair; however, may result in a large defect making primary, non-prosthetic repair impossible and increases the risk of abdominal compartment syndrome after surgical correction.

Traumatic abdominal wall hernia presents a diagnostic as well as a therapeutic challenge. The therapeutic approach is governed by a multitude of factors emphasizing the need of a patient-tailored, case by case management plan.