Introduction: Traumatic abdominal wall hernias (TAWH) are caused by the rupture of the muscle and fascial structures after high-energy blunt trauma, most of them with the integrity of the skin. Due to the rarity of its presentation, clinical diagnosis is generally infrequent, and treatment is controversial. We describe our experience with these hernias and their associated injuries, making special mention of a case of complete disruption of the abdominal wall. Materials and methods: Descriptive and retrospective study of the severe trauma registry at our trauma reference center in Madrid. Patients diagnosed with TAWH were studied over a 20-year period (2001–2020), analyzing demographic data, injury mechanisms, type and location of TAWH, associated injuries, and treatment. Results: During the study period, 692 patients with severe blunt abdominal trauma were registered. Six patients with TAWH were identified, aged between 20 and 64 years. The mechanism of injury was traffic collision, except for one bullhorn trauma. The diagnosis was established in three patients during clinical evaluation, in two by computed tomography (CT) scan, and the other during surgery. The TAWH were located mainly in the anterior wall (five cases), and one in the lumbar region. Five had associated intra-abdominal injuries, and two had bone fractures. There was a belt sign in two patients. Four patients required urgent surgery within the first 24 hours, with primary closure of the defect in two of them, and wall reconstruction with mesh in the others. No mortality was recorded, and an early hernia recurrence was observed in one patient. Conclusion: Traumatic abdominal wall hernia is a very rare injury that occurs in blunt trauma cases. Although they may be suspected in the clinical evaluation, confirmation is made by CT scan. It is important to individualize management and assess the risk-benefit balance of urgent or delayed wall reconstructions based on the associated injuries and the patient's clinical status. Clinical significance: The low incidence of TAWH leads to controversy in its management, with supporters for both urgent and deferred repair.