Stanislau Makaranka is a Foundation Year 2 Doctor working at University College London Hospital in London, UK. He has an interest and aspirations to go into plastic surgery and this year he published a case report on traumatic abdominal wall hernia, the course of which was complicated by pregnancy. It is a rare, albeit a very interesting and important topic, with a very specific message.
Abstract
Background:
Traumatic abdominal wall hernia (TAWH) is a rare type of hernia occurring secondary to blunt trauma, with a reported incidence of 0.2% on presentation CT scan1. There is currently no consensus regarding the optimum time for repair, though conservative management with serial imaging +/- expectant elective repair has been favoured.
Methods:
We present a case of a 20-year old female who was a seatbelt restrained rear-seat passenger in a road traffic collision and sustained two areas of Grade-5 TAWH along with bowel and colonic injuries. The patient was taken for an emergency laparotomy with initial conservative management of TAWH.
Results:
Four years post-index admission the patient’s abdominal wall was closed using Strattice Mesh. Delay was due to the inability of the patient to reach the 100-110kg goal operative weight and a pregnancy. During her pregnancy, the patient was managed by active surveillance involving the obstetric, plastics and trauma team.
Key messages:
This case illustrates successful delayed surgical repair of TAWH using biological mesh, without recurrence, demonstrating that elective repair provides a safe alternative to early repair in pregnancy.
We reiterate the importance of a multidisciplinary approach to TAWH, involving input from the trauma, plastic surgery, and obstetric – in the case of pregnancy – teams.
