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 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.