Traumatic abdominal wall hernia, what else?

Abstract text (incl. references and figure legends)

Male, 70 years old. Came to the emergency department due to increasing abdominal pain, after having fallen from a bicycle 4 days before.No relevant past medical history, no usual medication.Hemodynamically stable, no fever. GCS 15. Soft and depressing abdomen, with pain on palpation at the epigastrium. He had a hematoma of the abominal wall near the midline, without tension.The abdominal ultrasound showed an epigastric hernia corresponding to a palpable swelling with 8cm of major axis with fat and digestive loops.Diagnosed with painful traumatic abdominal hernia with indication of surgical treatment. It was operated on the same day: Midline hernioplasty with a polypropylene mesh on pre-periotneal space. Surgery and hospitalization without complications.Hospital discharge on the 3rd postoperative day. Follow-up at 6 months without recurrence and without complications.Comments: Traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after low- or high-velocity impact of the abdominal wall against a blunt object. It is defined as bowel or abdominal organ herniation through a disruption of musculature and fascia following severe blunt trauma. The prevalence of TAWHs in blunt trauma patients seen at a designated trauma center in published series is approximately 1 %. Owing to the rare incidence and complex nature of this condition, it is not possible to plan randomized control trials for optimal surgical management. The timing of surgery in any TAWH case should be considered depending on the severity of the trauma, the size of the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient. In this particular case the pation had pain wich was the main reason for urgent treatment. Ref: Indian Journal of Surgery; Traumatic Abdominal Wall Hernia: Early or Delayed Repair?, Published online 2014 May 7. doi: 10.1007/s12262-014-1083-9. ATLS, American College of Surgeons, 9th edition.

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