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Traumatic abdominal wall hernias and intra-abdominal organ injuries in children: A retrospective cohort study using

Andreina Giron1, Zoe Flyer, Alyssa Joachim

  • 1Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, California (A.G., Z.F., A.J., J.S., L.G., H.A.); Department of Surgery, University of California Irvine, Orange, California (J.N., L.G., H.A.).

The Journal of Trauma and Acute Care Surgery
|July 9, 2026
PubMed

Insights

Traumatic abdominal wall hernias (TAWHs) in pediatric patients are linked to a higher risk of hollow viscus injury (HVI), even with lower injury severity scores. This finding emphasizes the need for vigilant assessment for intra-abdominal damage in these cases.

Area of Science:

  • Trauma Surgery
  • Pediatric Surgery
  • Abdominal Wall Injuries

Background:

  • Traumatic abdominal wall hernias (TAWHs) are rare in pediatric trauma but can indicate severe intra-abdominal injuries, especially hollow viscus injury (HVI).
  • This study compares the incidence of HVI and solid organ injury (SOI) in pediatric patients with TAWH versus those with abdominal wall hematoma or ecchymosis.

Purpose of the Study:

  • To evaluate the association between pediatric TAWH and the incidence of HVI and SOI.
  • To determine if TAWH signifies a higher risk of intra-abdominal injury compared to less severe abdominal wall trauma.

Main Methods:

  • Retrospective analysis of the National Trauma Data Bank (2018-2022) involving patients aged 18 years or older.
  • Bivariate statistics and multivariable logistic regression were used to assess the association between TAWH and HVI/SOI, adjusting for demographics, vitals, and Injury Severity Score (ISS).

Main Results:

  • TAWH patients had higher rates of HVI (10.3% vs. 2.5%, p<0.0001) but similar rates of SOI (19.8% vs. 20.1%, p=0.89) compared to those with hematoma/ecchymosis.
  • Multivariable analysis confirmed TAWH was independently associated with increased odds of HVI (OR, 1.08; p<0.0001) but not SOI (OR, 0.98; p=0.55).
  • TAWH patients also showed increased rates of thoracic/lumbar spine and aortic injuries.

Conclusions:

  • Pediatric TAWH is associated with an increased risk of HVI, necessitating heightened clinical suspicion and thorough evaluation.
  • TAWH should be treated as a distinct entity due to differing injury patterns, prompting careful assessment for intra-abdominal injuries and consideration for early operative intervention.
Abstract

Keywords:
Hollow viscus injuryNational Trauma Data BankTraumatic abdominal wall herniapediatric traumasolid organ injury

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