Giant Post -Traumatic Umbilical Hernia - Abstract
Introduction: Traumatic Abdominal Wall Hernia (TAWH) is a rare kind of hernia. The diagnosis of TAWHs can be challenging and TAWHs may go undiagnosed for long periods of time.
Case presentation: A sixty-year-old male who had been involved in a car crash 10 years earlier was referred to us for a giant post-traumatic umbilical hernia. The clinical assessment revealed an irreducible huge hernia of the anterior abdominal wall with a port size of 7x13 cm containing intestinal loops with no radiological signs of ischemia or venous stasis. The patient underwent elective surgery consisting of an open approach with mesh.
Discussion: A study on 3,947 blunt trauma patients reported a 0.9% rate of TAWHs. The mechanisms hypothesized to lead to TAWHs are a sudden and marked increase in intra-abdominal pressure and/or acceleration-deceleration sheer forces impacting with a compressive seatbelt. The incidence of umbilical hernia reported in the literature is 2%. The diagnosis of TAWHs remains challenging owing to the patients’ conditions at the time of trauma, and the TAWH may escape diagnosis for a long period of time. The timing for surgical repair is driven by the severity of the injury and the size of the TAWH. The use of mesh in TAWH repair is debated, it being necessary to weigh up the advantages and the disadvantages of using mesh. In conclusion, TAWH is a rare entity that is, however, likely to be underestimated as a result of other, often severe, traumatic injuries the patient may have sustained.