A 40-year-old woman of north Indian origin was brought to the surgical emergency room 2 hours after being attacked by a bull near her home. The animal had struck her with its horns over her right lower abdomen. The patient complained of pain and swelling over the involved area. On examination, her vital signs were normal. There was no associated head, chest, pelvic, or limb injury. A bruise and a visible, ill-defined swelling over the right lumbar and umbilical regions were seen. On palpation, the area was tender, and the swelling decreased on gentle pressure, with gurgling sounds. A defect of 8 cm in maximum diameter could be palpated with irregular, ill-defined margins. On asking the patient to cough, bowel loops could be palpated through the defect. Since the patient was hemodynamically stable and the diagnosis clinically apparent, a transverse laparotomy was performed incorporating the site of injury. An irregular defect was found involving all subcutaneous layers of the abdominal wall, and was repaired with a preperitoneal mesh. There was no associated intra-abdominal injury. The patient's recovery was uneventful and she was discharged on the 3rd postoperative day. She had no recurrence after 1 year of follow-up.
A nearly 7-year-old boy, with no relevant past history, visited our emergency department with abdominal pain and swelling after a fall from his bike. Whilst riding his bike, he had fallen and his abdomen had landed on the handlebar. Immediately after the accident, his mother noticed a swelling where the handlebar had hit his abdomen. They visited the general practitioner on call who subsequently sent him to our emergency department. Apart from pain, he had no other complaints. On physical examination, he seemed to be not ill and he was haemodynamically stable. Examination of the abdomen showed a circular contusion of the skin several centimetres below the umbilicus just on the right of the midline (Fig. ). On palpation, a clear defect of the rectus fascia could be felt. There were no signs of peritonitis suggesting an enteral lesion. He was admitted for observation and discharged the following morning. He was scheduled for surgery 1 week later. During the operation, a skin-line incision was performed over the fascia defect, revealing a rupture of the musculus rectus abdominis, as well as a total rupture of the right rectus fascia (Fig. ). The rectus sheath was closed with a continuous Vicryl suture. The muscle defect was approximated with interrupted Vicryl sutures. The skin was closed intracutaneously. He was discharged the following day and recovered uneventfully.