Sigmoid colon perforation secondary to blunt abdominal trauma from cow hoof

Abstract

Introduction: Abdominal discomfort is one of the most prevalent complaints presented to the emergency department. When making a clinical diagnosis, blunt trauma with substantial visceral injuries requires a high index of suspicion.

Case presentation: The patient went to the emergency room after experiencing lower abdomen discomfort and a fever for two days. He was 40 years old. He says he was injured two days earlier when a cow foot landed on his stomach, causing mild blunt injuries. When examined, he is delicate all the way down in his lower belly. Results from the lab indicated a higher-than-normal total leucocyte count. Echogenic bowel thickening is seen on point-of-care ultrasonography (PoCUS) of the lower abdomen. Abdominal CT with contrast revealed oedema, heterogeneous enhancement, and a focal stretch of thickened circumferential mural including the sigmoid colon and peri-colonic fat stranding. Biopsy results from a sigmoidoscopy revealed significant sigmoid colon constriction and localized areas of active inflammation. Stricture development after a Sigmoid hole caused by a cow foot injury is an extremely unusual occurrence.

Discussion: This case emphasizes the need of a thorough history and physical examination, especially in a high-pressure emergency scenario, and the value of using ultrasonography at the bedside to make a definitive diagnosis and improve patient care.

Conclusion: Regardless of the severity of abdominal damage caused by cattle collision, early imaging should be explored since delaying action might result in poor results.

Keywords: Blunt abdominal trauma; Bowel perforation; Cow hoof injury; Emergency department; PoCUS.