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 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.