A 45-year-old male laborer was admitted in emergency department with complaints of pain abdomen and constipation. There was history of fall from a height on to a blunt object. Two days back, the patient was febrile and had tachypnoea and tachycardia. His blood pressure was in normal range. There was abrasion and bruise over the skin, along with surgical emphysema on right lumbar region. On abdominal examination, tenderness and guarding were elicitable in the right lumbar region. Blood tests were normal. USG of the abdomen revealed free fluid in the perihepatic region. Chest X-ray revealed gas under both domes of diaphragm.\nCECT of the abdomen showed a defect in the abdominal wall with herniation of small bowel loops []. Rest of the abdominal organs were normal. The abdomen was explored through a midline incision. There was a rent in the right rectus muscle with peritoneal disruption of approximately 8 cm in length. The ileal loops were herniating through the peritoneal defect. A solitary perforation of 2 cm in size was identified approximately 50 cm proximal to ileocaecal junction. Minimal peritoneal contamination was present. Loop illeostomy was done in left iliac fossa with repair of right lumbar defect in layers over a drain. Postoperative period was uneventful. Restoration of bowel continuity was done after 3 months. Patient is doing well in follow-up.
A 45-year-old man, gored by a cow was admitted in emergency department, within 2 h of injury. Patient complained of pain and swelling in the right lower quadrant with localized bruising. Vital signs were stable. On abdominal examination, a tender reducible bulge was present in the right fossa of size 5 × 8 cm2 with underlying fascial defect []. Routine blood tests and chest radiography were normal. USG of the abdomen revealed dilated bowel loops herniating through the defect with minimal fluid in the pelvis.\nOn laparotomy, there was minimal blood stained fluid and a large rent was present in right lower part of the rectus muscle. Ileal loops were reduced, and repair of the mesenteric tear was done. Rest of the intra-abdominal organs were normal. The muscular defects were repaired with absorbable sutures. Postoperatively patient recovered very well. Patient was discharged on 13th postoperative day. On follow-up at 6 months, patient is asymptomatic.