A case of traumatic abdominal wall hernia caused by a horn of cattle

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  • 牛角による外傷性腹壁ヘルニアの1例

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Abstract

A 68-year-old man who was horned by his cattle and bruised the left upper quadrant of abdomen in January 2010 was seen at a hospital on that day and was diagnosed with abdominal contusion. After he returned home, abdominal pain still persisted and he was seen at our hospital on the next day. When he was seen, a 12×10 cm bulge with subcutaneous hemorrhage was noted in the left upper quadrant of abdomen. An abdominal CT scan showed a herniated small intestine to the outside of the abdominal cavity from an injured portion of the rectus abdominis. The patient was admitted to our hospital to undergo emergency operation with a diagnosis of traumatic abdominal wall hernia on the same day. When the abdomen was opened by midline incision, we identified an about 5 cm-sized defect on the abdominal wall in the left upper quadrant of abdomen, just under the subcutaneous hemorrhage, through which the upper portion of the jejunum was incarcerated. No ascites and abdominal hemorrhage were seen. Hematoma due to strangulation was noted at the small intestine mesentery, but there were no findings of necrosis. Thus the small intestine was manually returned to the abdomen without intestinal resection. The peritoneum, striated muscle, and rectus abdominis were sutured respectively, and then the abdomen was closed. The postoperative course was uneventful and the patient was discharged from the hospital on the 15th postoperative day.<BR>We describe this case of traumatic abdominal wall hernia caused by a cattle's horn in which abdominal CT was useful in diagnosis.

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