Traumatic abdominal wall hernia as a component of the seatbelt syndrome: Complete abdominal wall muscles transection treated with two-stage surgery and retrospective review in a first-level hospital.

Background 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 with this condition. Material and Methods We present a review of our case series and the description of a unique case of a 21-year-old male with a high severity injury, with complete transection of all abdominal wall musculature secondary to SBS, with associated visceral injury. Emergency surgery required intestinal and sigmoid colon resection, as well as repair of the cava vein. After a long recovery period, a second-stage surgery was planned for abdominal wall reconstruction, with prehabilitation using botulinum toxin and pneumoperitoneum, as well as surgical planning with a CT scan with 3D reconstruction of the abdominal wall defect. Results A retrospective review was conducted of patients with SBS, of whom only 6 presented with TAWH. Five out of the 6 cases had associated intrabdominal visceral injuries, with emergency surgical treatment required. In the case of complete transection of the abdominal wall, a second surgery was required for scheduled abdominal wall reconstruction, involving transversus abdominis release and placement of double mesh. Discussion 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 serve as a valuable tool for preoperative planning in cases involving significant abdominal wall defects.