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.
A nearly 7-year-old boy, with no relevant past history, visited our emergency department with abdominal pain and swelling after a fall from his bike. Whilst riding his bike, he had fallen and his abdomen had landed on the handlebar. Immediately after the accident, his mother noticed a swelling where the handlebar had hit his abdomen. They visited the general practitioner on call who subsequently sent him to our emergency department. Apart from pain, he had no other complaints. On physical examination, he seemed to be not ill and he was haemodynamically stable. Examination of the abdomen showed a circular contusion of the skin several centimetres below the umbilicus just on the right of the midline (Fig. ). On palpation, a clear defect of the rectus fascia could be felt. There were no signs of peritonitis suggesting an enteral lesion. He was admitted for observation and discharged the following morning. He was scheduled for surgery 1 week later. During the operation, a skin-line incision was performed over the fascia defect, revealing a rupture of the musculus rectus abdominis, as well as a total rupture of the right rectus fascia (Fig. ). The rectus sheath was closed with a continuous Vicryl suture. The muscle defect was approximated with interrupted Vicryl sutures. The skin was closed intracutaneously. He was discharged the following day and recovered uneventfully.