Laparotomy for blunt abdominal trauma-some uncommon indications

Abstract

Trauma laparotomy after blunt abdominal trauma is conventionally indicated for patients with features of hemodynamic instability and peritonitis to achieve control of hemorrhage and control of spillage. In addition, surgery is clearly indicated for the repair of posttraumatic diaphragmatic injury with herniation. Some other indications for laparotomy have been presented and discussed. Five patients with blunt abdominal injury who underwent laparotomy for nonroutine indications have been presented. These patients were hemodynamically stable and had no overt signs of peritonitis. Three patients had solid organ (spleen, kidney) infarction due to posttraumatic occlusion of the blood supply. One patient had mesenteric tear with internal herniation of bowel loops causing intestinal obstruction. One patient underwent surgery for traumatic abdominal wall hernia. In addition to standard indications for surgery in blunt abdominal trauma, laparotomy may be needed for vascular thrombosis of end arteries supplying solid organs, internal or external herniation through a mesenteric tear or anterior abdominal wall musculature, respectively.

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.…”

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

“…Bullhorn-injury associated traumatic hernia (BATH) should be considered a distinct entity among TAWH as a large force acts over a very small area. Bullhorn injury may lead to high impact injuries that will present early[ 2 3 4 ] and may be associated with other injuries as well. It may also present as lower impact injuries which will usually be isolated injuries presenting late as reported by Nirhale et al .…”

“…In stable patients presenting late, delayed repair after few weeks (4–8 weeks) seems a valid option because it gives time for resolution of local edema, hematoma, and inflammation. Dharap et al .,[ 3 ] who have done repair in elective setting, used mesh for repair. Nirhale et al .…”

“…Very few such cases have been reported in literature. [ 1 2 3 4 5 ] We report here a case of a middle-aged male who presented on the 7 th day following bullhorn injury with a swelling above the right groin.…”