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 50-year-old male presented a day after sustaining blunt abdominal injury by a bull horn to the right side of his abdomen. He presented with right lower abdominal swelling. He was hemodynamically stable with a pulse of 82/min and a BP of 130/90 mm Hg. A chest X-ray diagnosed a right simple pneumothorax for which a chest tube was inserted. FAST exam was normal, but contrast CT revealed herniation of bowel through a defect in the anterior abdominal wall []. 3 days after injury, an exploratory laparotomy was done which showed no associated intraperitoneal injury and the hernia was reduced, and the defect reinforced with a mesh. The patient was discharged on postoperative day 7.