PubMed · 5926036
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I Macik. 1966. [Polytraumatism].. https://pubmed.ncbi.nlm.nih.gov/5926036/
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Twenty-two horses were examined because of firearm injuries. Nine had been shot with .22-caliber bullets, 2 with BB pellets, 6 with buckshot, 1 with a .35-caliber bullet, and 1 with an airgun pellet. Injury was confined to the skin or skeletal muscles in 8 horses. Of these, 7 returned to their previous use. In 14 horses, injuries to additional structures were incurred, including the sinus and pharynx (n = 2), mandible (n = 1), tooth (n = 1), aorta (n = 1), eye (n = 3), tibia (n = 1), gastrointestinal tract (n = 3), joint (n = 1), and trachea (n = 1). The 3 horses that had only eye injuries were discharged to their owners. Of the other 11 horses with injuries to deep/vital structures, 3 died, 5 were euthanatized, and 3 survived.
A 27-year-old female patient presented in our clinic 14 hours after onset of acute lower abdominal pain during sexual intercourse. Sonography showed ascites around the uterus and structures suspected to be clotted blood. Diagnostic laparoscopy showed in the abdomen about 400 ml of clotted blood: sources of bleeding were small injuries of the left sacro-uterine ligament. Therapy was not necessary, except careful rinsing since hemostasis was already complete. It is important to consider abdominal injuries in cases of abdominal pain after sexual intercourse, even if vulvar or vaginal injuries are absent.
Inguinal hernias are most feared to result in incarceration and strangulation of intra-abdominal structures. Blunt abdominal blows have previously been reported to cause traumatic perforation of bowel that overlays the defect of any abdominal wall hernia. To my knowledge, this case report is the first to show that bowel perforation may be caused by direct trauma to an inguinal hernia that contains a loop of small bowel. It is proposed that the force of the blow first opposes the walls of the incoming and outgoing bowel, sealing the loop. Then, additional pressure that is applied will raise the loop's intraluminal pressure to the point that traumatic perforation occurs. A simple experiment on a necropsy specimen showed that the proposed mechanism is plausible. This case points out another risk of leaving an inguinal hernia unrepaired.