Perineal Bull Gore with Urinary Bladder Perforation and Pneumoperitoneum

Abstract

Animal related injuries are frequently reported in India and other countries, where bulls are used for sporting events as well as in places where farming and livestock rearing is practised. The presentation is, many times, atypical and misleading as well.They have unique mechanics of injury. The patterns of the injury are reviewed. An intra-peritoneal urinary bladder injury which is caused by a perineal bull gore with a pneumoperitoneum is unusual and it has not been reported in the literature which was reviewed. We are reporting a successfully treated 25 years old male patient from the slopes of the southern district of Manipur, India, who had presented 40 hours after he was injured. The identification and prompt exploration, keeping in mind the mechanics of bull goring, helps the surgeons to adequately deal such atypical injuries, for optimal outcomes.SanthoSh R, aRun KumaR baRad, hemanth SuReShWaRa GhaliGe, SRidaRtha K, biRKumaR ShaRma m InTRoduCTIonAnimal related injuries are frequently reported in countries where bulls are used for sporting events as well as in places where farming and livestock rearing is practised [1,2]. In India, it is commonly seen in the "Jallikattu" event of taming bulls, which is organized as a part of Pongal -a festival of the harvest season which is celebrated across Tamil Nadu, India. Injuries, minor to fatal, are caused by bull gores. An intra-peritoneal urinary bladder injury which was caused by a perineal bull gore has not been reported in the available literature. One of the oldest reports which had described a bladder injury had come from Baron Jean Dominique Larry, who was a military surgeon to Napoleon Bonaparte, who had witnessed a drunken soldier trying his hand as a matador and entering the bull-ring. He was gored. Larry took him to the hospital, explored the wound, decompressed his bladder with a gum elastic catheter, and reduced the herniated bladder mucosa through the torn muscles of the groin. He was found to be cured six months later [3].The mechanics of bull goring are unique and often misleading and thence, they deserve reporting. We are reporting an unusual case with a bull gore injury to the perineum, who presented with a pneumoperitoneum and urinary bladder perforation. CASe SummARyA 25 year old male patient from the slopes of the southern district of Manipur, presented 40 hours after receiving a bull horn injury to the perineum. There was a history of extravasation of blood mixed urine through the perineal wound and the anus. At presentation, his vitals were found to be stable but he had signs of peritonitis and mild abdominal distention. He had a penetrating wound which was 3x1cms lateral to the anal orifice, on the right side [Table/ Fig-1], which was large enough to be digitally explored under local anaesthesia, with minimal patient discomfort. There was an abrasion on his buttocks, of nearly 10 cm, which tapered into it. A digital rectal examination and proctoscopy neither revealed any urine leak nor any sign of a rectal injury; there was no loss o...

Bison Goring Resulting in Abdominal Evisceration and Cervical Fracture: A Case Report

“…The injury pattern can be complicated by sepsis, fractures, or visceral bleeding (Santhosh et al, 2013). Antitetanus globulins should be administered because of horn contamination with dung-rich Clostridium welchii and C. Tetani spores (Santhosh et al, 2013). Antibiotic administration should include coverage for gram-positive, gram-negative, and anaerobic bacteria (Herrod et al, 2019; Santhosh et al, 2013).…”

“…Abdominal injuries can range from bladder perforation to vulvovaginal, anorectal, rectovaginal, urethrorectal, and prostatic urethra injuries, pelvic fractures, and pneumoperitoneum (Santhosh et al, 2013). The injury pattern can be complicated by sepsis, fractures, or visceral bleeding (Santhosh et al, 2013).…”

“…Abdominal injuries can range from bladder perforation to vulvovaginal, anorectal, rectovaginal, urethrorectal, and prostatic urethra injuries, pelvic fractures, and pneumoperitoneum (Santhosh et al, 2013). The injury pattern can be complicated by sepsis, fractures, or visceral bleeding (Santhosh et al, 2013). Antitetanus globulins should be administered because of horn contamination with dung-rich Clostridium welchii and C. Tetani spores (Santhosh et al, 2013).…”

Bladder rupture due to urogenital tract trauma caused by ox horn injury in a patient with pelvic organ prolapse: a case report

“…Physical trauma to the urogenital system due to horn injury is a rare phenomenon as the level of this system is lower than the head of the bull and the perineum is a highly protected region due to the reflex adduction of the thigh [ 5 , 11 ]. However, depending on the relative positions of the bull’s head and the victim an injury may occur to any part of the body [ 12 ]. This is clearly illustrated in our case, in which the patient was in squatting position preparing food for her cattle.…”