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 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.