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.
A 36-year-old male presented after a road traffic accident (RTA) with blunt abdomen injury and a right tibiofibular fracture. He has the pulse of 72/min and blood pressure (BP) of 112/70 mm Hg with a normal FAST exam. The patient was transferred to the orthopedic unit for further management but developed complaints of vomiting and constipation with abdominal distension over the next 3 days. Abdominal X-ray [] revealed multiple air fluid levels and a contrast CT with oral and intravenous (IV) contrast revealed an obstruction at the jejunoileal junction. A decision was taken to do a diagnostic laparoscopy on day 4 after injury, which was converted to open laparotomy due to findings of internal herniation of ileal loops through the transverse mesocolon. This herniated ileal loop had vascular compromise so it was resected, and an ileo-ileal end to end anastomosis was done. The postoperative period was uneventful, and the patient was discharged on postoperative day 7.