Traumatic abdominal wall hernia as a component of the seatbelt syndrome: A case report of complete abdominal wall muscle transection

Introduction and importance: Seat belt syndrome (SBS) is a rare condition described as injuries sustained due to thoracic, abdominal, and pelvic compression in the context of traffic accidents. These injuries can range from minor skin abrasions to large lesions of internal organs and spinal cord involvement. Traumatic abdominal wall hernias (TAWH) are one of the injuries that can be associated. Case presentation: A 21-year-old male suffered a severe injury, resulting in complete transection of all abdominal wall musculature due to SBS, with associated visceral injury. Emergency surgery included intestinal and sigmoid colon resection, along with cava vein repair. After a prolonged recovery, a second-stage surgery for abdominal wall reconstruction was planned. Prehabilitation involved botulinum toxin and pneumoperitoneum, with surgical planning utilizing CT scan and 3D reconstruction. The second-stage surgery included transversus abdominis release and placement of double mesh. Clinical discussion: Managing traumatic abdominal wall hernias in polytrauma patients necessitates emergent surgery for vital injuries, while reconstructive surgery timing is crucial, with patient preparation being essential. Surgical planning, including 3D reconstructions, enhances accuracy, and safety, with repair technique selection depending on anatomical features. Given our patient's athletic background and preoperative vascular CT findings, flapless reconstructive surgery was chosen to mitigate vascular risks. Conclusion: The therapeutic approach to traumatic abdominal wall injuries should be individualized to each patient, with a focus on addressing vital injuries first and considering abdominal wall reconstruction surgery at a subsequent stage. Utilizing CT scan with 3D reconstruction can be a valuable tool for preoperative planning in cases involving significant abdominal wall defects.