A rare case of bullhorn-injury associated traumatic hernia of anterior abdominal wall managed by laparoscopic sutured tissue-only repair

Abstract

Traumatic abdominal wall hernias (TAWHs) are relatively uncommon entities. Common mechanisms that predispose to such hernias include motor vehicle accidents, seat belt injuries, fall from height, handlebar injuries, and bullfighting. Bullhorn injury leading to TAWHs is an uncommon mechanism. We report here one such patient who was managed by laparoscopic transperitoneal anatomical repair of the defect using polypropylene suture. The patient recovered well without any complication and is being followed up. Such small defects can be managed laparoscopically and tissue-only repair using a nonabsorbable suture is a feasible option. Our case is the first reported case of bullhorn-injury associated traumatic hernia managed laparoscopically and first reported case of TAWH in an adult which was managed by laparoscopic sutured tissue-only repair.

Abdominal herniation associated with bullhorn injury as a separate entity from traumatic abdominal wall hernias

“…Only 12 such previously reported cases were found during our literature review, which met the inclusion criteria mentioned above – five as case reports,[ 2 3 4 5 6 ] three cases as part of case series on blunt abdominal trauma,[ 7 8 9 ] one case as letter to editor,[ 10 ] two more cases as part of discussion on bullfight-associated injuries in Spain,[ 11 12 13 ] and one case as a teaching case in online radiologic teaching file. [ 14 ] Various relevant aspects of these cases have been discussed in detail in the following discussion.…”

“…Injuries caused by the horn of a cow, bull, buffalo, ox, or bison would all constitute a bullhorn injury for all practical purposes; however, injuries due to the horn of a bull are the most commonly described form of horn injuries. [ 19 ] Only 12 such previously reported cases were found during our literature review[ 2 3 4 5 6 7 8 9 10 11 12 13 14 ] which have been summarized in Table 1 . Very interestingly, most of the described incidents are from the Indian subcontinent.…”

“…[ 4 7 8 11 ] Low-impact injuries would be isolated injuries presenting late. [ 2 3 6 ] For example, in the case reported by Singh et al , the patient was hit by a standing bull, and he fell down on the ground and thus constitutes a low-impact type injury. [ 2 ] Had the bull been charging toward the person hitting with force, as occurs in bullfights,[ 11 12 13 ] the injury may be considered a high-impact injury, and the possibility of associated injuries is high.…”

“…[ 2 3 6 ] For example, in the case reported by Singh et al , the patient was hit by a standing bull, and he fell down on the ground and thus constitutes a low-impact type injury. [ 2 ] Had the bull been charging toward the person hitting with force, as occurs in bullfights,[ 11 12 13 ] the injury may be considered a high-impact injury, and the possibility of associated injuries is high. Another possible mechanism of high-impact bullhorn injury is being held by the bull in his horn and then being thrown away on to the ground or against a wall, but this mechanism might not cause the classically described BATH.…”

“…In case of injury to intra-abdominal viscera, a patient presenting immediately may present without features of peritonitis as in the case reported by Singal et al [ 7 ] BATH may also present as a tender palpable lump with ecchymosis and contusion of overlying skin. [ 2 7 ] Presentation in such cases may be early (especially in high impact injuries) or delayed. BATH may be associated with extra-abdominal injuries such as pelvic, lumber, and rib fractures when significant kinetic energy is involved.…”