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

## TL;DR

This case report describes a rare injury from seatbelt syndrome causing complete abdominal muscle damage and highlights the importance of staged surgical treatment and 3D imaging for planning.

## Contribution

Presents a unique case of complete abdominal wall muscle transection due to seatbelt syndrome and emphasizes individualized surgical planning using 3D reconstruction.

## Key findings

- Seatbelt syndrome can cause complete abdominal wall muscle transection with visceral injury.
- 3D CT reconstruction aids in surgical planning for complex abdominal wall defects.
- Flapless reconstructive surgery was chosen to reduce vascular risks based on patient-specific factors.

## Abstract

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.

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.

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.

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.

•Seat belt syndrome: trauma from compression, leading to internal injuries and traumatic hernias•Polytraumatic patient initial treatment: prioritize life-threatening injuries; address abdominal wall later•CT scan with 3D images can aid planification for abdominal wall surgery with large muscle defects.•Patient prehabilitation ensures optimal preoperative condition and postoperative outcomes.•Consider patient traits, needs, and anatomy conditions when choosing surgical technique

Seat belt syndrome: trauma from compression, leading to internal injuries and traumatic hernias

Polytraumatic patient initial treatment: prioritize life-threatening injuries; address abdominal wall later

CT scan with 3D images can aid planification for abdominal wall surgery with large muscle defects.

Patient prehabilitation ensures optimal preoperative condition and postoperative outcomes.

Consider patient traits, needs, and anatomy conditions when choosing surgical technique