Traumatic abdominal wall hernias and intra-abdominal organ injuries in children: A retrospective cohort study using the National Trauma Data Bank.

BACKGROUND

Traumatic abdominal wall hernias (TAWHs), though rare in pediatric trauma, may signal severe associated intra-abdominal injury, particularly hollow viscus injury (HVI). This study evaluated whether pediatric TAWH is associated with a higher incidence of HVI and solid organ injury (SOI) compared with abdominal wall hematoma or ecchymosis.

METHODS

We performed a retrospective analysis of the National Trauma Data Bank (2018-2022), including patients 18 years of age or older with TAWH or abdominal wall hematoma/ecchymosis. Bivariate statistics and multivariable logistic regression assessed the association between TAWH and HVI and SOI, adjusting for demographics, vitals, and injury severity score (ISS).

RESULTS

Among 13,261 patients, 414 (3.1%) had TAWH and 12,847 (98.1%) had abdominal wall hematomas/ecchymoses. TAWH patients presented with lower median SBP (116 vs. 120 mm Hg, p <0.0001) and median ISS (5 vs. 9, p <0.0001). Median hospital length of stay was shorter in TAWH patients (2 vs. 3 d, p =0.0003). However, TAWH patients had increased rates of HVI (10.3% vs. 2.5%, p <0.0001), but no difference in rates of SOI (19.8% vs. 20.1%, p =0.89). TAWH patients also had increased rates of thoracic and lumbar spine injuries (20.5% vs. 14.7%, p <0.0001), as well as thoracic and abdominal aortic injuries (20.7% vs. 2.8%, p <0.0001). Multivariable analysis confirmed TAWH was independently associated with increased odds of HVI (odds ratio, 1.08; confidence interval, 1.067-1.105; p <0.0001), but not associated with SOI (odds ratio, 0.98; confidence interval, 0.95 - 1.02; p =0.55).

CONCLUSIONS

Pediatric TAWHs are associated with increased risk of HVI despite lower ISS, highlighting the need for heightened clinical suspicion and thorough evaluation. The difference in injury patterns between TAWH and abdominal hematoma highlights the need for treating TAWH as a distinct entity. Recognition of TAWH should prompt careful assessment for intra-abdominal injuries and consideration for early operative intervention. ( J Trauma Acute Care Surg. 2026;101: 458-463. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).

LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.