A 40-year-old woman of north Indian origin was brought to the surgical emergency room 2 hours after being attacked by a bull near her home. The animal had struck her with its horns over her right lower abdomen. The patient complained of pain and swelling over the involved area. On examination, her vital signs were normal. There was no associated head, chest, pelvic, or limb injury. A bruise and a visible, ill-defined swelling over the right lumbar and umbilical regions were seen. On palpation, the area was tender, and the swelling decreased on gentle pressure, with gurgling sounds. A defect of 8 cm in maximum diameter could be palpated with irregular, ill-defined margins. On asking the patient to cough, bowel loops could be palpated through the defect. Since the patient was hemodynamically stable and the diagnosis clinically apparent, a transverse laparotomy was performed incorporating the site of injury. An irregular defect was found involving all subcutaneous layers of the abdominal wall, and was repaired with a preperitoneal mesh. There was no associated intra-abdominal injury. The patient's recovery was uneventful and she was discharged on the 3rd postoperative day. She had no recurrence after 1 year of follow-up.
A 60-year-old female presented with obstipation and vomiting following blunt trauma abdomen in the emergency department 2 days back. Patient had fallen from a bullock cart and had sustained blunt trauma abdomen. There was history of obstipation and vomiting. Vitals were stable. She was obese, and abdomen was moderately distended. There was bruising over the skin in right iliac fossa. Abdominal examination revealed a tender reducible mass of 15 × 20 cm2 size in the right iliac fossa. Routine blood investigations were within normal limits. CECT abdomen showed a defect in the anterior abdominal wall above the right iliac crest with herniation of ascending colon and small gut along with avulsed muscle seen in right lumbar region and stranding of subcutaneous fat [Figure and ] There was minimal fluid in the pelvis.\nExploratory laparotomy was performed through an incision over the swelling and findings were a 15-cm wide gap in the aponeurotic part of the external oblique muscle, with small bowel loops along with caecum and ascending colon herniating into the defect. After reduction of herniated contents, abdominal wall defect was repaired primarily with reinforcement by onlay prolene mesh. Patient was discharged in satisfactory condition. On follow-up after 8 months, patient is doing well and asymptomatic.