AN UNUSUAL CASE OF PENETRATING INJURY ABDOMEN THROUGH UPPER

THIGH

INTRODUCTION
Abdominal injuries are typically classified as blunt or penetrating. Penetrating trauma is an
injury that occurs when an object pierces the skin and enters a tissue of the body, creating an
open wound. It usually involves a direct injury to the abdomen and diagnosis can be made.
Here we are presenting a unique case of penetrating injury of the abdomen through an injury
to the upper thigh.
CASE REPORT
A 29yr old male patient presented with an alleged history of bull gore injury, with complaints
of lower abdominal pain with a wound over the left thigh. On examination the patients vitals
were stable and local examination revealed a lacerated wound with omentum prolapsed.

Fig 1: Clinical picture showing prolapsed omentum

PER ABDOMEN EXAMINATION: The findings were non-specific with diffuse tenderness
over the lower abdomen. No guarding and rigidity was seen. Bowel sounds were present.
USG ABDOMEN: Ultrasound showed no free fluid and solid abdominal organs were found
to be normal.
Patient was taken up for exploratory laparotomy.
SURGERY: Through a lower midline incision abdomen was opened and thorough
laparotomy was done. Omentum was found to be plugged in the left iliac fossa, thigh wound
was explored simultaneously and the prolapsed omentum was reduced into the peritoneal
cavity. The Omentum was found to be prolapsed through a peritoneal breach and through the
space between the inguinal ligament and the femoral canal. Femoral vessels were uninjured.
Part of the omentum was found to be congested and Partial omentectomy was done. Breach
closed intraperitoneally. Thigh wound closed in layers.

Fig 1: showing the connection between the thigh wound and abdomen

DISCUSSION:
Penetrating trauma is an injury caused by a foreign object piercing the skin, which damages
the underlying tissues and results in an open wound. The most common causes of such
trauma are gunshots and stab wounds. Clinical features differ depending on the injured parts
of the body and the shape and size of the penetrating object. [1]
The most common organs injured are the small bowel (50%), large bowel (40%), liver (30%),
and intra-abdominal vascular (25%). When the injury is close range, there is more kinetic
energy than those injuries sustained from a distance. Stab wounds that penetrate the
abdominal wall are difficult to assess. A variety of injuries of all the structures in the
abdomen can be injured up to the diaphragm from penetrating wounds to the gluteal area has
been reported. [2] But our case is unique as it has occurred through a thigh wound. A rare
case of bladder injury through a thigh wound was reported. It was missed initially and patient
was discharged and later readmitted with haematuria. Cystourethrography was done and
patient was managed conservatively with continuous bladder drainage for 14 days. [3][4]
Occult injuries can be missed, resulting in delayed complications that can add to the
morbidity. [5][6][7]
Management usually involves supportive measures (haemostasis, blood transfusion,
respiratory support), and surgical repair of damaged structures and/or removal of foreign
bodies.
CONCLUSION
This is a rare case of a penetrating injury of the abdomen. To our knowledge an injury with
this particular trajectory and mechanism has not been described previously in literature. It
stands as a reminder that genitourinary trauma and other abdominal organs can have many
points of origin.
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3. Urol Case Rep. 2015 Nov; 3(6): 226–229. Published online 2015 Oct 1. doi:
10.1016/j.eucr.2015.08.003 Bladder Injury From Penetrating Trauma of the Inner
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