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Traumatic Abdominal Wall Hernia in Children: A Systematic Review
Christina M Theodorou1, Sarah C Stokes1, Alana L Beres1
1Department of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California.
Insights
Traumatic abdominal wall hernias in children are rare but often involve serious intra-abdominal injuries. Management is typically surgical, with low recurrence rates observed in this systematic review.
Area of Science:
- Pediatric surgery
- Trauma surgery
- Systematic reviews
Background:
- Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury resulting from blunt abdominal trauma.
- There is no established consensus for managing these rare pediatric cases.
- This systematic review aims to consolidate current knowledge on TAWH in children.
Purpose of the Study:
- To systematically review and describe the characteristics of traumatic abdominal wall hernias in pediatric patients.
- To analyze the associated injuries, management strategies, and outcomes for pediatric TAWH.
- To provide insights into the current understanding and treatment of this rare condition.
Main Methods:
- A systematic literature search was conducted following PRISMA guidelines across major databases (PubMed, Web of Science, Embase, Google Scholar).
- English-language publications detailing blunt TAWH in patients under 18 years old were included.
- Data extraction focused on demographics, injury mechanisms, associated intra-abdominal injuries, surgical management, and patient outcomes.
Main Results:
- A review of 71 articles identified 100 cases of pediatric TAWH, predominantly in males (82.5%) with a median age of 9 years.
- Bicycle handlebar injuries were the most frequent cause (72%), followed by motor vehicle collisions (14%).
- Intra-abdominal injuries occurred in 40% of patients, significantly more common with non-bicycle handlebar trauma (60.7% vs. 33.3%). Laparotomy was the primary surgical approach (80%), with low reported complications and no recurrences at a median follow-up of 5 months.
Conclusions:
- Pediatric traumatic abdominal wall hernia is a rare injury associated with a high incidence of intra-abdominal damage, especially from high-impact events.
- While open repair is common, successful laparoscopic approaches have been documented.
- Observed recurrence rates are low, though long-term follow-up data remain limited.
Background:
Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature to describe injuries, management, and outcomes.
Materials And Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed, Web of Science, Embase, and Google Scholar was performed to identify English-language publications of blunt TAWH in patients <18 y old. Conflicts were resolved by consensus. Data were collected on demographics, associated injuries, management, and outcomes.
Results:
A total of 71 articles were reviewed with 100 cases of TAWH. A total of 82.5% of patients were male, and the median age was 9 y old (range 2-15). Injury by bicycle handlebars was most common (72%) followed by motor vehicle collision (14%). Forty patients had intraabdominal injuries, most commonly bowel (70%) or mesentery (37.5%). Rate of intraabdominal injury was significantly higher in patients with injuries due to nonbicycle handlebar injuries when compared with bicycle handlebar injuries (60.7% versus 33.3%, P = 0.02). Most patients were managed operatively (85%), most commonly via laparotomy (68/85, 80%), with six laparoscopic repairs and five laparoscopic converted to open repairs. There were three reported complications and no recurrences over a median of follow-up of 5 mo in patients who underwent repair.
Conclusions:
Pediatric TAWH is a rare injury with a high rate of intraabdominal injuries, particularly when due to high-impact mechanisms such as motor vehicle collision. Although open repair is more commonly performed, laparoscopic repair has been described with success. Recurrence rates appear low, but follow-up has been short term.
