gms | German Medical Science

The incidence of blunt abdominal trauma has increased since the legislation of seat belt wearing worldwide. In high force car accident a trauma pattern called “seat belt syndrome” appears when seatbelt is worn, including fracture of the sternum, bruise of the skin, injury to the abdominal wall and intestinal viscera. A trauma CT-scan might not show the intestinal injuries, or signs from it. Therefore a laparotomy may be indicated. We report a case of a 55 year old man admitted at our department after a front-end collision. CT-scan showed rupture of the abdominal wall muscles but no radiologic signs of intestinal injury. An emergency laparotomy was performed. It showed an acute traumatic abdominal wall hernia with transversal disruption of the muscular wall (right and left rectus abdominis muscle and left sided flank musculature) and multiple injuries to the intestinal viscera. A reconstruction of the abdominal wall by mean of primary suture of the disrupted muscles and resection with anastomosis of the injured bowel was performed. Due to the extended traumatic changes of the abdominal wall a negative pressure wound therapy was administered with repeated lavages and debridements until the wound healed. The postoperative course was uneventful and the patient was discharged on 41st day after admission in well condition, with a small secondary healing wound.