Traumatic transfemoral bowel evisceration following bull horn injury: a case report and review of literature

Bull horn injuries produce complex shearing and penetrating forces capable of causing occult abdominal wall disruption with visceral herniation. We report a rare case of bowel evisceration through the thigh following bull horn injury associated with pelvic fractures and traumatic inguino-femoral disruption. A 55-year-old female presented to the emergency with bowel loops protruding through a lacerated wound over the anterolateral aspect of the right thigh following a bull horn injury. Contrast-enhanced computed tomography of the abdomen and pelvis revealed herniation of ileal loops with mesentery through a large right lower abdominal wall defect with possible femoral canal involvement. Exploratory laparotomy revealed mesenteric tears and traumatic disruption of the inguinal region allowing bowel migration into the thigh. Reduction of bowel loops, repair of mesentery, peritoneal lavage and inguinal ligament repair were performed successfully. This case highlights the importance of suspecting occult abdominal wall and inguino-femoral disruption in atypical bowel evisceration patterns following animal-inflicted trauma.