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 23-year-old male presented with deceleration injury following an RTA. His hemodynamic parameters were within the normal range; he had a pulse of 80/min and a BP of 110/78 mm Hg. Examination revealed a soft abdomen. The FAST exam was positive, and a CT with oral and IV contrast revealed a completely devascularized spleen. The patient was conservatively managed and started on a liquid diet but developed abdominal pain with associated fever after a week. An exploratory laparotomy was done 8 days after injury, and a splenectomy was done for splenic infarction with abscess formation. He had an uneventful postoperative period and went home on postoperative day 7.