Left Abdominal Wall Research Articles

Giant Bowen’s disease of anterior abdominal wall with invasive squamous cell carcinoma-A rare case report

A 65 years old male presented to the out-patient department of Dermatology with complaints of a large verruco-erosive lesion on left anterior abdominal wall for 15 years. A wedge incision biopsy was done which showed features of Bowen’s disease. The patient was referred to department of General Surgery where a complete excision was done. The final histopathology report confirmed the diagnosis of Bowen disease with a focus of invasive carcinoma component. This case report is unusual for its clinical presentation, duration and location of the lesion.

A case of non-traumatic rectus sheath hematoma in a post-kidney transplant patient undergoing catheter embolization during anticoagulation treatment for atrial fibrillation.

A 65-year-old man, a post living donor kidney transplant patient, was admitted to the intensive care unit (ICU) with a severe bacterial infection. He also tested positive for coronavirus disease and had a cough. On admission, heparin was administered for atrial fibrillation. On the third day of hospitalization, his general condition had recovered, and he was discharged from the ICU to the general ward. On the fourth day of hospitalization, he experienced abdominal pain, and a hard mass was palpated in the left lower abdomen. On the fifth day of hospitalization, contrast-enhanced computed tomography showed an extensive rectus sheath hematoma (RSH) extending from the left lower abdominal wall to the left side of the bladder, with extravasation from a small branch of the left inferior epigastric artery. Heparin was discontinued, and transcatheter arterial embolization was performed to control the bleeding. RSH is a rare disease, and cases of extensive hematoma in post-kidney transplant patients occur even less frequently. Patients taking anticoagulants and those with chronic kidney disease are at high risk for RSH, so physicians should be cognizant of this disease when these patients develop abdominal pain.

Endovascular treatment of traumatic pseudoaneurysm of the ileal branch of the superior mesenteric artery in a 9-year-old girl: Case report and literature review.

Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection. A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision. Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury. Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding. Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm. Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.

Acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster: a case report and review of the literature

BackgroundHerpes zoster is a common disease that can affect men and women at any age. Sensory neuropathy is the most common complication while motor neuropathy of the abdominal muscles is rare complication appearing in ~ 0.7% of patients. Furthermore, visceral nerve involvement causing gastroparesis is an extremely rare postherpetic complication. We present an extremely rare case of acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster infection.Case presentationA 91-year-old Asian man was admitted to hospital with 2-day history of vomiting and left abdominal protrusion. He was previously treated for a rash on the left abdominal wall as herpes zoster infection with oral valaciclovir 2 weeks prior. On physical examination, characteristic herpes zoster rash scars and an ipsilateral abdominal bulge were observed on the left side. Computed tomography revealed no abdominal wall defect, mass, or stenosis. Remarkable distension of the stomach, asymmetrical left flank wall bulge, and a thinner abdominal wall on the left compared with the right side were shown. He was diagnosed as acute gastric dilatation owing to gastroparesis and segmental paresis of the abdominal musculature associated with herpes zoster infection. The patient showed significant improvement in symptoms and abdominal paresis within a month of conservative treatment, including nasogastric tube decompression and mosapride administration.ConclusionAcute gastric dilatation with abdominal paresis is an extremely rare complication of herpes zoster infection, and to date there have been no reports in the literature. It alerts us that, when examining patients with abdominal bulge, we should be conscious of this rare pathology for the optical diagnosis, avoiding unnecessary invasive examination or surgical exploration.

An innovative reconstruction of an enbloc resected composite giant chest and abdominal wall chondrosarcoma with 3D-composite mesh

BackgroundChest wall chondrosarcomas, although common, pose unique challenges due to their aggressive nature, rarity of abdominal wall involvement, and propensity for recurrence. We highlight the critical role of meticulous surgical planning, multidisciplinary collaboration, and innovative reconstruction techniques in achieving optimal outcomes for patients with composite giant chest and abdominal wall chondrosarcoma.Case PresentationA 38-year-old female patient presented with progressive left chest and abdominal wall swelling for two years; on evaluation had a large lobulated lytic lesion arising from the left ninth rib, scalloping eighth and tenth ribs measuring 13.34 × 8.92 × 10.71 cm (anteroposterior/transverse/craniocaudal diameter) diagnosed with chondrosarcoma grade 2. A three-dimensional (3D) composite mesh was designed based on computed tomography using virtual surgical planning and computer-assisted design and manufacturing technology. She underwent wide local excision and reconstruction of the chest and abdominal wall with 3D-composite mesh under general anesthesia. The postoperative condition was uneventful, with no recurrence at 12 months follow-up.ConclusionA 3D-composite mesh facilitates patient-specific, durable, and cost-effective chest and abdominal wall reconstruction.

Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature

Abstract Traumatic abdominal wall hernia (TAWH) is a rare clinical occurrence, with only limited cases published since 1906. This type of hernia is primarily caused by low- or high-energy blunt force trauma, resulting in damage to abdominal wall musculature while the skin is intact. The diagnosis and management of TAWH poses a lot of challenges and complexities. Herein, we present a case of a 32-year-old male Saudi patient who sustained significant abdominal trauma as a driver involved in a front collision while wearing a seat belt. Upon arrival at the trauma center, the patient was hemodynamically stable and exhibited clinical signs of left flank bulge, seat belt sign, and abdominal bruising. First, a focused assessment with sonography for trauma (FAST) was performed, which revealed minimal free fluid in the abdomen. Subsequent contrast-enhanced IV computed tomography (CT) scan confirmed a 3.6-cm left lateral abdominal wall defect with herniation of short segments of the large and small bowel loops and adjacent subcutaneous fluid. Following initial observation, the patient developed signs of bowel obstruction. A repeat CT scan showed interval progression of the hernia, partial small bowel obstruction, and other concerning findings. An emergency laparoscopic exploration revealed a large defect at the left lumber region containing omentum and long segments of the small bowel with mild distension. The bowel and omentum were reduced. The surgical repair included herniorrhaphy and mesh placement. The patient recovered well and was discharged on the third postoperative day. This case underscores the importance of thorough evaluation and timely intervention in TAWHs. Rapid surgical management, aided by advanced imaging techniques, can lead to favorable outcomes even in complex cases involving bowel herniation and associated complications.

Malignant Peritoneal Mesothelioma Complicating Familial Mediterranean Fever on 18 F-FDG PET/CT.

A 77-year-old man with a personal history of familial Mediterranean fever presented with a slowly enlarging tumefaction of the left abdominal wall and persistent inflammatory syndrome despite good adherence to colchicine. 18 F-FDG PET/CT showed a hypermetabolic muscular mass of the abdominal wall along with other hypermetabolic lesions including a peritoneal mass and several subcutaneous soft tissue nodules. CT-guided needle biopsy led to the diagnosis of a muscular localization of a malignant peritoneal mesothelioma, which is an extremely rare complication of familial Mediterranean fever. Six courses of chemotherapy with carboplatin and pemetrexed allowed an almost complete response.

Reconstruction of an Abdominal Hernia after Wide Tumor Resection with Multilayer Acellular Dermal Matrix and Skin Graft: A Case Report

An abdominal hernia is a relatively common complication after abdominal surgery. However, no reports have previously described the reconstruction of a soft tissue defect with a hernia after wide excision of a tumor in the abdominal wall. A 41-year-old man presented with a painless, rapidly growing mass in his abdominal wall. Enhanced magnetic resonance imaging of the abdomen revealed a 7.8×6.4×4.2 cm mass, consistent with a soft tissue sarcoma suspected to be angiosarcoma in the subcutaneous layer of the left anterior upper abdominal wall. After wide excision of the mass, a hernia measuring 6.0×5.8 cm was observed. The abdominal hernia was repaired using multilayered acellular dermal matrix (ADM), and the soft tissue defect was covered with a split-thickness skin graft. A histopathological examination confirmed that the mass was fibrosarcomatous dermatofibrosarcoma protuberans (DFSP-FS). No complications occurred after surgery, and the patient was followed up for 10 months without any issues. Herein, we present a case of hernia after the removal of DFSP-FS in the abdominal wall, which was repaired using multilayer ADM and a split-thickness skin graft.

Colocutaneous fistula with recurrent urinary tract infection: a delayed complication following laparoscopic transabdominal pre-peritoneal repair

There has been an increase in incidence of delayed complications following transabdominal pre-peritoneal repair (TAPP) for inguinal hernia in the last two decades. Mesh related visceral complications (MRVCs) are difficult to diagnose and treat. Colocutaneous and colovesical fistualas are rare yet devastating delayed complications caused by mesh migration. We present the case of a 40-year-old man who presented to us after numerous hospital visits with urinary symptoms and a recurring fistula on the left abdominal wall at a previously operated site. Computed tomography revealed an ill-defined collection in left loin region abutting the sigmoid colon and urinary bladder. Owing to acute angulation, the colonoscope could not be passed beyond 30 cm. The patient was managed with cystoscopy, laparotomy, mesh explantation, and sigmoid colon resection.

A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal Pain: A Case Report.

BACKGROUND This report details the case of a 35-year-old woman who presented with cyclical abdominal pain diagnosed as cesarean scar endometriosis. Scar endometriosis is a phenomenon that occurs after abdominal/pelvic procedures like cesarean sections; after which, it is called cesarean scar endometriosis. It is frequently misdiagnosed as hernias, granulomas, abscesses, hematomas and neoplasms, and thus needs proper investigation to diagnose. The classic triad of symptoms are a positive surgical history, cyclical pain, and a mass at the surgical scar. Magnetic resonance imaging (MRI) is the imaging of choice owing to its high sensitivity and specificity when diagnosing scar endometriosis. CASE REPORT We report a 35-year-old woman who presented to the Obstetrics and Gynecology (OB/GYN) clinic with a triad of positive surgical history (cesarean section), cyclical abdominal pain, and an abdominal mass. Physical examination revealed a protruding, hyperpigmented mass at the left corner of the Pfannenstiel incision. An MRI was done, which showed a 3×3×3.5 cm left lower abdominal wall soft-tissue mass. A clinical diagnosis of scar endometriosis was made based on suggestive history, physical examination, and imaging. The mass was surgically removed and the patient made a full recovery. CONCLUSIONS Cesarean scar endometriosis is a complication of cesarean sections and should be a differential diagnosis when considering female patients with an abdominal mass and cyclical pain following an abdominal surgical procedure. A clinical diagnosis is made on the basis of thorough history-taking, physical examination, and imaging (particularly MRI). The criterion standard treatment is surgical excision.

Diagnosis of struma peritonei 15 years after rupture of mature teratoma

Background: Struma peritonei is an extremely rare presentation of struma ovarii. Case: Here we report the case of a 38-year-old woman with a history of papillary thyroid cancer, left ovary struma ovarii, ruptured mature cystic teratoma of the right ovary, and endometriosis presenting with pelvic pain, dysmenorrhea, abnormal uterine bleeding, and infertility. A diagnostic laparoscopy was performed to evaluate for recurrence of endometriosis. However, multiple abnormal appearing lesions were found on her left hemidiaphragm and left abdominal wall. The tissue was identified as ectopic thyroid tissue identical to the patients ruptured mature cystic teratoma which occurred 15 years prior. A second subsequent laparoscopy was performed to excise the lesions. Eleven additional lesions were identified as ectopic thyroid tissue. This peritoneal dissemination was likely a result of tissue seeding post-mature teratoma rupture. Conclusion: Gynecologists should consider the possibility of struma peritonei in patients who have a history of papillary thyroid cancer and struma ovarii who present with significant pelvic pain and abnormal uterine bleeding.

Giant cell tumor of soft tissue: A case report

Giant cell tumor of soft tissue (GCT-ST) is a rare primary neoplasm of soft tissues. It usually involves superficial and deeper soft tissues of upper and lower extremities, followed by trunk. A 28-year-old female, presented with a painful mass in left abdominal wall for three months. On examination, it measured 4×4cm with ill-defined margins. CECT showed ill-defined enhancing lesion deep to muscle planes with possible invasion of peritoneal layer. Histopathology showed multinodular architecture with intervening fibrous septa and metaplastic bony tissue encasing the tumor. Tumor composed of round to oval mononuclear cells and osteoclast like multinucleated giant cells. Mitotic figures were eight per hpf. A diagnosis GCT-ST of anterior abdominal wall was made. Patient was treated with surgery followed by adjuvant radiotherapy. Patient is disease free at one year follow up. These tumors mostly involve extremities and trunk and usually presents as a painless mass. Clinical features depend upon the exact location of the tumor. Common differential diagnosis includes tenosynovial giant cell tumors and malignant giant cell tumors of soft tissue and GCT of Bone. Diagnosis of GCT-ST is difficult on cytopathology and radiology alone. Histopathological diagnosis should be done to rule out the malignant lesions. Complete surgical resection with clear resection margins is the mainstay of treatment. Adjuvant radiotherapy should be considered in case of incomplete resection. Long follow-up is necessary for these tumors as local recurrence and risk of metastasis cannot be predicted.

A Giant Left Common Iliac Artery Aneurysm with Endovascular Repair: A Case Report

Common iliac artery aneurysm (CIAA) is a very rare entity, but with potentially disastrous evolution, aneurysm rupture or distal embolization. A specific management, surgical or endovascular procedure, is required. We present a case with a huge distal left common iliac artery aneurysm, in which the diagnosis was made incidentally during a weekly ultrasound examination, in spite of impressive dimensions, 9 cm diameter. The patient was then examined by 128- Slices computed tomography and angio-coronarography. Despite the attractive anatomy for direct surgery with resection of the aneurysm and restoration of the iliac tract through the interposition of a tubular prosthesis, due to the previous pathology of the patient with necrotizing fasciitis in the left lower limb and abdominal wall, endovascular intervention was decided. Because, the big size of the left common iliac artery aneurysm, located distally, with tortuosity of the left common iliac artery as well external iliac artery (EIA), permeable left internal iliac artery (IIA), extensive intra-aneurysmal thrombosis, endovascular procedure was complex and particular. The peculiarities of the case and the complex endovascular technique, with the placement of a stent graft on the infrarenal abdominal aorta, extended on both common iliac arteries, embolization of the left internal iliac artery and extension of the left arm on the external iliac artery, are described in this presentation.

Primary upper lumbar hernia repaired by transabdominal preperitoneal approach technique using a self-expanding mesh with a memory-recoil ring, report of a case

BackgroundUpper lumber hernia is a rare entity which can cause obstruction and strangulation. Laparoscopic technique has been considered effective for such hernia repairs; however, there is no report of use of the self-expanding mesh.Case presentationA 77-year-old woman visited to our hospital complaining of a bulge of about 5 cm in the left lumbar dorsal region while standing. Abdominal CT and MRI scans showed a fascial defect in the left lumbar abdominal wall and confirmed the presence of a hernia, in which retroperitoneal fatty tissue and the descending colon protruded. Transabdominal preperitoneal repair (TAPP) was performed and the operative findings revealed the hernia orifice, 3 × 2.5 cm in diameter, between two intercostal nerves. To avoid nerve injury or entrapment, the number of mesh fixation was desirable minimum; therefore, a self-expanding mesh with a memory-recoil ring was used. The mesh, 9.5 × 13 cm in diameter, was placed and tacked to the abdominal wall at two points, 1 cm ventral and dorsal to the hernia orifice. The postoperative course was uneventful and no pain or recurrence was observed with follow-up of 6 months.ConclusionWe herein present a case of upper lumber hernia successfully repaired by TAPP with a self-expanding mesh.

Cutaneous fistulization: An extremely rare presentation of hydatid liver cyst in a child.

We report the case of a 10-year-old child who presented with a renitent lesion on the left abdominal wall. Clinical, radiological, and intraoperative findings concluded to a cutaneous fistulization of a hydatid cyst of the left lobe of the liver. The diagnosis was confirmed by histopathological examination. The child was successfully treated with acombination of medical and surgical management. Complicated hydatid disease should be considered in the differential diagnoses of patients presenting with cutaneous fistulization, particularly in regions where hydatid disease is endemic.

Gastroinstestinal Fistula in Acute Necrotising Pancreatitis with Septicaemia: A Case Report

Acute Pancreatitis (AP) is an inflammatory condition with cumbersome side effects. Gastropancreatic (GI) fistula is a rare complication seen in cases with infected pancreatic or peripancreatic necrosis. GI fistulas can result in severe haemorrhage and septicemia. Hereby, the authors present a case of 36-year-old male with a chief complaint of abdominal pain associated with abdominal distension and non bilious vomiting after binge consumption of alcohol for the past 10 days. Computed Tomography (CT) scan showed the presence of free gas in the abdomen. Contrast-Enhanced CT (CECT) imaging revealed diffuse enlargement affecting the head, uncinate process, body, and tail of the pancreas. There were also a few necrotic peripancreatic fluid collections with extensive peripancreatic fat stranding. Based on these findings, the diagnosis of acute necrotising pancreatitis was suggested. Despite treatment with antibiotics and necrosectomy with drainage of the abscess collection, the patient showed no improvement. A repeat CECT examination was performed due to the deterioration of the patient’s clinical condition, which showed a complete non enhancing pancreas. Additionally, a large defect measuring approximately 16 mm was observed in the posteroinferior wall of the stomach at the middle third of the body, with extravasation of contrast material into the pancreatic collection, suggestive of fistula formation. Subsequently, the patient underwent pancreatic necrosectomy with closure of the gastric perforation using feeding jejunostomy. A follow-up CT examination was performed four days later due to the deteriorating status of the patient, as well as new onset haematemesis and bloody discharge from the surgical drain. The CT scan revealed a few peripancreatic soft tissue infiltrates adjacent to the pancreatic head. Persistent collections were noted along the anterolateral surface of the right psoas, extending to the adjoining right anterior pararenal space and the left anterolateral abdominal wall in the left hypochondriac region. Thickening of the bilateral lateroconal fascia and anterior and posterior renal fascia was observed, likely due to inflammation. Following this, the patient underwent another surgery, and percutaneous drainage was performed with antibiotic coverage. The patient showed a significant reduction in the collection and improved clinical condition after 10 days. Imaging plays a crucial role in diagnosing such complications, enabling early detection and reducing mortality in these patients.

Conservative treatment of rectus sheath hematoma after diagnostic laparoscopy

This case report aims to present rectus sheath hematoma's diagnosis and conservative treatment process after diagnostic laparoscopy in a patient with right lower quadrant pain. A sixty-seven-year-old lady was admitted with abdominal pain, right inguinal pain, and nausea for about five days. She had coronary artery disease followed by acetylsalicylic acid. On physical examination of the abdomen, there was tenderness and defence on deep palpation. No pathology was seen on laboratory parameters, ultrasonography (USG) and computed tomography (CT). Despite medical treatment, the patient's complaints did not improve, so a laparoscopic appendectomy was performed. A mass was detected in the left lower abdominal wall of the patient at the sixth postoperative hour. The control hemogram level of the patient was 10.8 g/L, a 3.7 g/L haemoglobin decrease compared to the preoperative period. A left rectus sheath hematoma was detected on CT. The hematoma was treated conservatively. On the 12th day of her hospitalisation, the patient with a haemoglobin value of 10.9 g / L was discharged without complications.

DESMOID TUMOUR OF ANTERIOR ABDOMINAL WALL: A CASE REPORT

Desmoid tumours are broblastic neoplasms which show aggressive inltrative behaviour and can cause mass effect. They should be monitored for asymptomatic patient as there is a possibility of spontaneous regression. For patients with rapidly growing or symptomatic tumors resection is recommended. If complete pathologic resection is not achievable without signicant morbidity, more modest resection is recommended along with treatment with adjuvant therapies. A 36-year-old female presented to the surgery OPD with the complaint of lump in left iliac fossa for last 2 years, initially 3 x 2 cm in size but gradually increasing in size with stable vitals and examination nding of lump palpable in left iliac fossa of size 20 x 15cm, hard in consistency, not xed to skin, mobile, non-tender and becoming prominent on leg raising test. MRI pelvis was suggestive of 17.1 x 12.8 x 11.4cm, T2 hypointense lesion in left hemipelvis with extension into the hypogastrium and left iliac fossa, inltrating the left anterior abdominal wall in the left iliac fossa and hypogastrium and reaching to skin surface via large defect in the abdominal wall size, abutting and displacing the urinary bladder and left external and internal iliac vessels with the angle of contact less than 90 degrees with the vessels and left ovary not visualised separate from the lesion. FNAC was suggestive of spindle cell tumour. The patient successfully underwent wide local excision along with left oopherectomy, mesh repair and transverse rectus abdominis myocutaneous (tram) ap. Conclusion: Since, desmoid tumors are locally aggressive and invasive, timely surgical intervention with resection in this patient prevented further progression of the tumour and the high probability of invasion and involvement of major blood vessels thus signicantly reducing the fatality.

7692 An Approach to Imaging and Surgical Excision of Abdominal Wall Endometriosis

<h3>Study Objective</h3> To demonstrate an approach to the imaging and surgical management of abdominal wall endometriosis (AWE) including the surgical repair of abdominal wall defects. <h3>Design</h3> Video case presentation. <h3>Setting</h3> Pre-operative imaging suite and operating room. <h3>Patients or Participants</h3> To illustrate our approach, we present two surgical cases. The first is of a patient who was referred with catamenial pain in the left lower abdominal wall. She has a history of 2 previous cesarean sections and a lesion, consistent with abdominal wall endometriosis was demonstrated on ultrasound, adjacent to her previous cesarean section scar. The second case is a patient with peri-umbilical abdominal wall endometriosis. <h3>Interventions</h3> In both cases, we demonstrate our technique for resection of abdominal wall endometriosis. We discuss a 3-step approach: 1. Landmarking and incision making 2. Dissection and excision 3. Fascial repair. Larger fascial defects may require fascial mobilization off surrounding tissue to allow for a tension-free closure or mesh placement in the abdominal wall. These techniques may be performed together in consultation with a general surgeon and are further described within this video. <h3>Measurements and Main Results</h3> Pre-operative ultrasound accurately predicted abdominal wall endometriosis and surgical excision results in symptom relief. <h3>Conclusion</h3> Ultrasound is the first line diagnostic test to confirm clinical suspicion of abdominal wall endometriosis. MRI can be used to further characterize lesion extent and structures involved. Surgical excision of abdominal wall endometriosis can be safely performed by the gynecologic surgeon in conjunction with general surgery if resection results in a large abdominal wall defect.

P-129 TRAUMATIC HERNIA, URGENT REPAIR?

Abstract Aim We present our clinical experience in the urgent repair of traumatic hernias through two clinical cases. Material and Methods Case 1: A 45-year-old man suffering thoraco-abdominal trauma due to running over. Thoracoabdominal CT scan and surgical examination shows a meso tear of terminal ileum and traumatic section of the right lateral musculature. Case 2: A 19-year-old man suffering abdominal trauma due to a traffic accident. CT abdomen is performed which reports large traumatic hernia of the left anterior abdominal wall including intestinal loops, with pneumo and retroneumoperitoneum. Results Case 1: We close the mesenteric gap and repair musculature by associating a polypropylene mesh in the preperitoneal space. The patient is discharged after 13 days. During the two-year follow-up, no hernia recurrence was detected. Case 2: A reconstruction of the wall is performed associating posterior separation of left components, in addition to ileocecal and sigma resection with anastomosis. As a complication presents seroma and chronic sinus, without hernia recurrence during follow-up for 5 years. Conclusions The tendency in traumatic hernias is their repair in a second time attending first to injuries that compromise the survival of the patient, but larger defect can lead to irreversible sequelae since enlargement of hernia, atrophy and muscle retraction, resulting in a more complex repair. If the patient requires urgent surgical intervention for visceral injury, some authors defend the simultaneous repair of the hernia in stable patients. Our group thinks that patients requires individualized management and its urgent repair will depend on the clinical situation.