In the setting of severe trauma, abdominal injuries are common and potentially life-threatening. Such injuries predominantly affect parenchymal organs, particularly the liver and spleen. Hollow organ injuries occur less frequently but nevertheless require timely and accurate diagnosis as well as appropriate surgical management to avoid severe complications, including peritonitis and sepsis. In daily clinical practice, different surgical strategies are employed for the management of hollow organ injuries. According to overall injury severity and abdominal injury patterns, treatment may involve either definitive single-stage surgery or staged procedures incorporating damage control principles. This study aimed to retrospectively evaluate the incidence and patterns of surgical management of hollow organ injuries in severely injured patients and to describe postoperative course and complications associated with different treatment strategies. Between 2006 and 2020, 1794 patients aged ≥ 16 years with an Injury Severity Score (ISS) ≥ 16 were treated at University Medical Center Regensburg, a level 1 trauma center. Among these, 57 patients sustained transmural hollow organ and/or mesenteric injuries requiring surgical intervention. Definitive surgical management during the initial operation was performed in 20 patients, whereas 37 patients underwent staged management with at least one planned secondary procedure. Patients managed with staged approaches exhibited higher overall injury severity and more complex abdominal injury patterns, including combined hollow organ and/or mesenteric injuries in 24.3%. Surgical treatment comprised bowel repair, resection with anastomosis, ostomy formation, or combinations of these techniques, carried out either during the initial operation or during planned subsequent procedures. No bowel leakage requiring revision surgery occurred following single-stage management. By contrast, bowel leakage necessitating unplanned reoperation was observed in 4 of 37 patients (10.8%) treated with staged approaches. In this retrospective single-center analysis, single-stage definitive surgical management was mainly observed in patients with moderate overall injury severity and less complex abdominal injury patterns, whereas staged strategies incorporating damage control principles were more frequently applied in patients with higher injury severity and complex abdominal injuries. These findings indicate that single-stage management may represent a feasible option in selected severely injured patients, while more complex injury patterns are more commonly managed using an individualized, staged surgical approach.