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Blunt Traumatic Abdominal Wall Hernias: An Indicator for Emergent Laparotomy?
Adora T Santos1,2, Olivia Jagiella-Lodise1,2, Phillip Kim1,2
1Emory University School of Medicine, Atlanta, GA, USA.
The American Surgeon
|May 4, 2023
Summary
Traumatic abdominal wall hernias (TAWH) indicate a high risk of internal injury. Immediate surgery is often needed, but nonoperative management may be safe without other signs of damage.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Abdominal Wall Reconstruction
Background:
- Traumatic abdominal wall hernias (TAWH) are uncommon but associated with significant injury risk.
- Shearing forces causing TAWH may also lead to visceral damage.
- Evaluating the link between TAWH and intra-abdominal injury is crucial.
Purpose of the Study:
- To determine if TAWH presence necessitates emergent laparotomy.
- To assess the association between TAWH and intra-abdominal injuries.
Main Methods:
- Retrospective review of trauma registry data (8-year period).
- Inclusion of adult patients (age > 15) with blunt thoracoabdominal trauma and TAWH.
- Analysis of demographics, injury mechanisms, injury severity scores (ISS), BMI, length of stay, TAWH size, repair type, and outcomes.
Main Results:
- 64 out of 38,749 trauma patients (0.17%) had TAWH.
- 42.2% of TAWH patients required emergent laparotomy, often for perforated viscus.
- 9.4% of patients initially managed nonoperatively later needed delayed laparotomy.
Conclusions:
- TAWH presence alone warrants immediate laparotomy for intra-abdominal injury evaluation.
- Nonoperative management can be considered safe for TAWH in the absence of other surgical indications.
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