Delayed Multi-Compartment Traumatic Hernias After Blunt Abdominal Trauma: A Case-Based Review of Diagnosis and Staged Management.

Abstract

BackgroundTraumatic diaphragmatic hernias (TDHs) and traumatic abdominal wall hernias (TAWHs) are uncommon sequelae of blunt abdominal trauma (BAT) and may be missed during the initial evaluation. Delayed presentation can occur months to years later, resulting in incarceration, obstruction, or respiratory compromise.Case PresentationA 61-year-old woman presented 1 year after a motor vehicle collision with abdominal pain, nausea, constipation, and dyspnea. Computed tomography demonstrated an incarcerated left diaphragmatic hernia containing colon and omentum, along with a right flank hernia containing ascending colon. Review of prior imaging revealed a flank hematoma and subtle abdominal wall disruption at the time of initial injury. The patient underwent urgent laparoscopic repair of the diaphragmatic hernia followed by elective robotic transabdominal preperitoneal repair of the flank hernia 2 months later.DiscussionThis case illustrates a pattern of delayed multi-compartment traumatic herniation resulting from thoracoabdominal force transmission. Diagnostic delays may occur because of competing priorities during polytrauma management, limitations of initial imaging, and delayed development of herniation, especially when the injuries are subtle. Findings such as rib fractures, pneumothorax, abdominal wall hematoma, and persistent symptoms should prompt continued surveillance.ConclusionDelayed multi-compartment traumatic hernias represent a diagnostic challenge requiring a high index of suspicion, longitudinal surveillance, and individualized management. A staged operative approach based on symptom severity and anatomic location can effectively address differing levels of clinical urgency.