Traumatic abdominal wall hernia: Delayed repair: Advantageous or taxing.

INTRODUCTION

Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair.

PRESENTATION OF CASE

A 35yr old obese male with RTA was diagnosed with TAWH with 19cm×15cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30cm×45cm was found extending from midline anteriorly to 8cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60cm×60cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence.

DISCUSSION

Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases.

CONCLUSION

TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.