Rhinoceros-related delayed traumatic diaphragmatic rupture [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-73857 | DOI: 10.14744/tjtes.2019.73857  

Rhinoceros-related delayed traumatic diaphragmatic rupture

Michael Sebastian1, ALIA Abdullah1, Mohamed Abusharia1, Fikri M Abu-Zidan2
1Department of Surgery, Al-Ain Hospital, Al-Ain, UAE
2Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE

Introduction: 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 women who presented three years after a rhinoceros gored her chest.
Case presentation: 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 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 7 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 s 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 surgery.
Conclusions: 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.

Keywords: Rhinoceros, trauma, injury, rupture diaphragm




Corresponding Author: Fikri M Abu-Zidan, United Arab Emirates


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