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 35-year-old male presented with blunt abdominal trauma after an RTA along with injury to left lower limb. His hemodynamic parameters were normal, with a pulse of 100/min and a BP of 110/70 mm Hg. He had generalized abdominal tenderness and guarding. The FAST exam was positive, and X-ray revealed a left shaft of femur fracture. CT with IV contrast revealed no enhancement in both kidneys in the arterial phase suggestive of bilateral renal pedicle injury []. Endovascular stenting of both renal arteries was attempted unsuccessfully the next day after injury. Laparotomy was done 2 days after the injury due to the failure of endovascular stenting, and a right aortorenal artery polytetrafluoroethylene grafting was done on the right side. On the left side, a splenectomy was done, and the splenic artery anastomosed with the left renal artery. Patient underwent repeated dialysis in the postoperative period. His urine output returned to normal but after 4 days, he succumbed due to his injury. summarizes all the cases.