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 45-year-old male laborer was admitted in emergency department with complaints of pain abdomen and constipation. There was history of fall from a height on to a blunt object. Two days back, the patient was febrile and had tachypnoea and tachycardia. His blood pressure was in normal range. There was abrasion and bruise over the skin, along with surgical emphysema on right lumbar region. On abdominal examination, tenderness and guarding were elicitable in the right lumbar region. Blood tests were normal. USG of the abdomen revealed free fluid in the perihepatic region. Chest X-ray revealed gas under both domes of diaphragm.\nCECT of the abdomen showed a defect in the abdominal wall with herniation of small bowel loops []. Rest of the abdominal organs were normal. The abdomen was explored through a midline incision. There was a rent in the right rectus muscle with peritoneal disruption of approximately 8 cm in length. The ileal loops were herniating through the peritoneal defect. A solitary perforation of 2 cm in size was identified approximately 50 cm proximal to ileocaecal junction. Minimal peritoneal contamination was present. Loop illeostomy was done in left iliac fossa with repair of right lumbar defect in layers over a drain. Postoperative period was uneventful. Restoration of bowel continuity was done after 3 months. Patient is doing well in follow-up.