Traumatic abdominal wall hernias: a 20-year retrospective cohort study.

Background: Traumatic abdominal wall hernias (TAWHs) are uncommon but serious injuries resulting from blunt abdominal trauma. Despite their low incidence, the associated morbidity and mortality rates necessitate effective management strategies. This study aims to assess the incidence, injury patterns, and optimal management strategies for TAWHs. Method: This retrospective cohort study was conducted at a level-1 trauma center in Melbourne, Australia, spanning 20 years. Patients diagnosed with TAWHs between October 2002 and October 2023 were identified through trauma and radiological databases. Results: Out of 220 patients identified, 71 were confirmed to have TAWHs. The mean age was 45.2 years. High-speed motor vehicle collisions were the most common injury mechanism. About 54% of patients required intensive care unit admission, and 53.5% underwent trauma laparoscopy/laparotomy. Key factors necessitating immediate operation included CT findings of free gas, perforation, degloving injury, hypoattenuation suggestive of bowel ischemia, and traumatic bowel injury. Additional CT findings significantly associated with intra-abdominal injury were free fluid, hematoma, contrast extravasation to suggest active hemorrhage, and bowel herniation through the hernia defect. The majority of patients without these CT findings were successfully managed conservatively, with the option of elective mesh repair. Conclusion: Our study highlights the need for clinical vigilance in high-energy trauma cases and the use of CT in diagnosis. Although trauma laparotomy is essential for suspected intra-abdominal injury, select hemodynamically stable patients may be safely managed non-operatively. Level of evidence: III, diagnostic test/criteria.