title: Traumatic abdominal wall hernia: epidemiology and clinical implications.
abstract: BACKGROUND
  Traumatic abdominal wall hernias (TAWHs) are uncommon, and it remains controversial whether such patients require urgent laparotomy. As such, this study was undertaken to assess the clinical sequelae of operative versus nonoperative management of TAWH, and whether certain patient or injury characteristics are predictive of the need for early surgery.
  
  
  METHODS
  Retrospective review of all patients presenting acutely with a TAWH at a Regional Trauma Center from January 2000 to December 2004.
  
  
  RESULTS
  Thirty-four patients were identified (age 39 +/- 12 years; Injury Severity Score 31 +/- 13). The most frequent mechanism of injury was motor vehicle collision (MVC; 24 cases), followed by motorcycle collision (6) and falls (4). The diagnosis of a TAWH was made primarily by computed tomography scan. Overall, 19 patients underwent urgent laparotomy or laparoscopy (56%) and 15 patients required bowel resection (44%). TAWH secondary to a MVC more frequently required urgent laparotomy and bowel resection than other mechanisms (p < 0.05). All three patients with clinically apparent anterior TAWH had intra-abdominal injuries and required urgent laparotomy. Only eight patients (24%) had their TAWH repaired acutely. At follow-up, two patients managed nonoperatively had symptomatic hernias, and three patients that had had an early repair had developed recurrent hernias.
  
  
  CONCLUSIONS
  First, the mechanism of injury should be considered when deciding if a patient with a TAWH needs an urgent laparotomy. Clinically apparent anterior TAWHs appear to have a high rate of associated injuries requiring urgent laparotomy. Finally, occult TAWHs diagnosed only by computed tomography may not require urgent laparotomy or hernia repair.
authors.affiliation: Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Fernando A C Spencer
authors.initials: FA
authors.lastname: Netto
authors.forename: Paul
authors.initials: P
authors.lastname: Hamilton
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: Bartolomeu
authors.initials: B
authors.lastname: Nascimento
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Brenneman
authors.forename: Homer
authors.initials: H
authors.lastname: Tien
authors.forename: Lorraine N
authors.initials: LN
authors.lastname: Tremblay
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D005260:Female; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000601:surgery; D007813:Laparotomy; D008297:Male; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000150:complications*