Traumatic abdominal wall injuries in postmortem CT

BACKGROUND: Traumatic abdominal wall hernia (TAWH) is a rare manifestation of blunt trauma, usually linked to high-energy mechanisms such as motor vehicle collisions. While uncommon in clinical series, its true frequency in fatal trauma is poorly understood. This study aimed to determine the incidence of TAWH in postmortem computed tomography (pmCT) of traffic fatalities and to evaluate associated injury patterns, with particular focus on motor vehicle occupants (MVO). METHODS: We retrospectively reviewed traffic fatalities between January 2011 and July 2023 at a single forensic institute. Of 411 cases, 218 underwent diagnostic pmCT and were systematically assessed for TAWH, defined as disruption of abdominal wall musculature or fascia. Demographic data, seatbelt status, accident details, and associated injuries were recorded. Statistical analyses included Chi-square and Mann-Whitney U tests. RESULTS: TAWH was identified in 45 of 218 cases (20.6%), substantially higher than the 0.17-1.5% reported in clinical trauma cohorts. Within the MVO subgroup (n = 72), 14 cases (19.4%) demonstrated TAWH. All cases with documented restraint status occurred in seatbelted occupants (7/30). Strong correlations were found with sternal fractures, serial rib fractures, lumbar transverse process fractures, and sacroiliac joint injuries. No significant associations were observed with age, sex, or seating position. CONCLUSION: TAWH is a significant indicator of fatal high-energy trauma and is much more prevalent in postmortem examinations than in clinical settings. Its association with injury patterns characteristic of seatbelt loading suggests diagnostic relevance in restrained occupants. Awareness of TAWH may improve recognition of severe trauma mechanisms, and further biomechanical research is needed to clarify thresholds and mechanisms.