ACUTE TRAUMATIC ABDOMINAL-HERNIA - CASE-REPORTS

Traumatic abdominal hernia is a rare injury with most reports document ing only one or two such cases. We describe five cases that were recog nized during a 22-year period at a single trauma center. Physical exam ination often revealed abdominal wall tenderness and ecchymosis, but c onfirmation of hernia required additional testing in four of five pati ents. Two patients sustained muscle avulsion from the iliac crest whic h was likely a result of obesity and high riding seatbelts. In three o f the patients a computed tomographic scan of the abdomen was instrume ntal in making the diagnosis. Surgical repair of the hernia was accomp lished in three patients. The other two patients were managed nonsurgi cally. This report documents that an individualized approach to these patients is appropriate. Diagnosis may be difficult and immediate surg ery does not prevent late sequelae. Management guidelines based upon a review of the English language literature on traumatic abdominal wall hernias are presented.