Open AccessRhinoceros-related delayed traumatic diaphragmatic rupture
Author(s) -
Michael Sebastian,
Alia Abdullah,
Mohamed I. Abusharia,
Fikri M. AbuZidan
Publication year - 2019
Publication title -
ulusal travma ve acil cerrahi dergisi
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 0.28
H-Index - 22
ISSN - 1306-696X
DOI - 10.14744/tjtes.2019.73857
Subject(s) - medicine , rhinoceros , laparotomy , abdomen , surgery , diaphragm (acoustics) , diaphragmatic breathing , abdominal pain , hernia , vomiting , pathology , paleontology , physics , alternative medicine , acoustics , loudspeaker , biology
Animal-related injuries should be analyzed based on the behavior and anatomy of the attacking animal. Rhinoceros-related injuries in humans are extremely rare. Hereby, we report a life-threatening traumatic diaphragmatic hernia in a woman who presented three years after a rhinoceros gored her chest. A 47-year-old lady presented with abdominal pain, bilious vomiting and obstipation of one-day duration. She had recurrent attacks of colicky abdominal pain for a week before that. The patient gave the history of being admitted to the ICU three years before, after being gored by a rhinoceros into her chest while working as a veterinary assistant in the zoo. On examination, the abdomen was distended but soft and lax. Bowel sounds were exaggerated. Abdominal x-rays showed multiple air-fluid levels. A gastrographin follow through study hold up in the small bowel and did not reach the colon after seven hours. Abdominal and chest CT scan showed the splenic colonic flexure to be located in the left chest through a left diaphragmatic hernia. Urgent laparotomy showed a healthy splenic flexure of the colon that herniated through a 4 cm postero-lateral defect in the left diaphragm. The colon was reduced, and the defect was repaired with non-absorbable sutures. Postoperative recovery was smooth. The patient was discharged home 10 days after the surgery. Rhinoceros-related injuries in humans are extremely rare. Life-threatening traumatic diaphragmatic herniation may be delayed for few years. High index of suspicion is needed for its diagnosis.