A 38-year-old north Indian man was brought to the emergency department of our hospital after suffering a head-on collision while driving his car. On examination, he was conscious, oriented, and, in severe pain. His vital signs were normal, except for tachycardia. There were no signs of head, chest, pelvic, or limb injury. A visible swelling was present in the umbilical and epigastric regions with overlying bruising of the skin (Figure ). On palpation, it was tender, firm, non-pulsatile, and non-reducible, but there was a slight increase in size over the next hour. The patient was triaged as a blunt trauma abdomen - a probable steering wheel injury, hemodynamically stable, with probable rectus hematoma. Expectant treatment was started and a computed tomography (CT) scan was performed. The CT scan (Figure ) revealed a supra-umbilical defect in the midline anterior abdominal wall (maximum diameter 5 cm), with herniation of bowel loops and mesentery through it, with extensive interstitial edema. There was also associated free fluid in the peritoneal cavity, and a minor splenic laceration. Anticipating strangulation of the bowel, the abdomen was explored through a midline incision. There were 2-3 loops of edematous jejunum and mesentery in the subcutaneous space, herniating from a full-thickness defect in the abdominal wall. There was also a mesenteric hematoma with loss of vitality of the corresponding jejunal segment (one foot). A resection-anastomosis was performed. No other solid organ injuries were seen. The defect was repaired with an interrupted monofilament polypropylene suture without tension. The patient's wound healed without complications and was discharged on the 6th day. He was asymptomatic, 1 month after the operation.
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.