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Acute Abdominal wall ( Ventral ) Hernia with Intestinal Obstruction… An Unusual presentation-

Bull Horn Penetrating Injury to Abdomen

Close Up Look at the Penetrating Injury

Patient Presented with a history of Bull Horn Injury to right lower abdomen, 4 days back, followed by Acute onset symptoms of Intestinal Obstruction like Abdominal Pain, Vomiting, Distention and Constipation.

CT scan of the Abdomen was suggestive of Obstructed Hernia in Right Lower Abdomen.

CT scan showing Obstructed Hernia in Right Lower Quadrant

Emergency exploration in right lower quadrant of Abdomen revealed Obstructed Small Bowel loop which was Dusky in colour herniating through a Small defect in the Anterior Rectus sheath and Peritoneum.

Dusky looking small bowel loop herniating through a small defect in Rectus Sheath.

On incising the rectus sheath, colour of the obstructed loop returned back to normal.

Normal Healthy Bowel loop after Incising the sheath

Contents were reduced and the Defect was closed Anatomically with Non Absorbable Sutures

Contents reduced back in the abdomen revealing the defect in the sheath

Patient tolerated the procedure well and was discharged after 4 days, tolerating full diet and relieved completely of his symptoms.

© Copyright 2019 Dr. Amol Joshi

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