A 43-year-old middle-aged male of thin built and average nutrition came to us with 5-day history of a swelling, about 2 cm in size, above the right groin. The swelling appeared on coughing and straining only. He had history of being hit by a bull using its horn at the same site 1 week back. At presentation, patient's vitals were within normal limit for his age. On examination, a resolving yellowish-brown 2 cm × 1 cm bruise was present at the alleged site of injury that was 4 cm medial to anterior superior iliac spine and 2 cm above the deep inguinal ring []. On coughing, a small bulge of about 3 cm appeared at the site of injury []. Ultrasonography (USG) revealed a small defect in the anterior abdominal wall with no free fluid in peritoneal cavity or any solid organ injury. No free intraperitoneal gas was visualized on the erect chest X-ray. Since the patient was hemodynamically stable with no apparent sign of internal abdominal injury, the patient was planned for laparoscopic repair of defect. The patient was admitted after 6 weeks. A contrast-enhanced computed tomography (CECT) of the abdomen was done to define the defect. It revealed a small defect of approximately 2 cm size in the anterior abdominal wall []. The patient was planned for a laparoscopic mesh repair of the hernial defect. However, intraoperatively, we found a small clean split defect in the muscle and fascial layers of anterior abdominal wall of <2 cm size []. Thus, an anatomic tissue repair of the defect in single layer was done transperitoneally using continuous nonabsorbable 1-0 polypropylene sutures []. Patient's postoperative course was uneventful and the patient was discharged on day 3. The patient has been in follow-up for the past 6 months without any reported complication.
A 60-year-old female presented with obstipation and vomiting following blunt trauma abdomen in the emergency department 2 days back. Patient had fallen from a bullock cart and had sustained blunt trauma abdomen. There was history of obstipation and vomiting. Vitals were stable. She was obese, and abdomen was moderately distended. There was bruising over the skin in right iliac fossa. Abdominal examination revealed a tender reducible mass of 15 × 20 cm2 size in the right iliac fossa. Routine blood investigations were within normal limits. CECT abdomen showed a defect in the anterior abdominal wall above the right iliac crest with herniation of ascending colon and small gut along with avulsed muscle seen in right lumbar region and stranding of subcutaneous fat [Figure and ] There was minimal fluid in the pelvis.\nExploratory laparotomy was performed through an incision over the swelling and findings were a 15-cm wide gap in the aponeurotic part of the external oblique muscle, with small bowel loops along with caecum and ascending colon herniating into the defect. After reduction of herniated contents, abdominal wall defect was repaired primarily with reinforcement by onlay prolene mesh. Patient was discharged in satisfactory condition. On follow-up after 8 months, patient is doing well and asymptomatic.