A bull gore injury: a rare case report and review of the literature

Abstract

Background: Bull gore injuries are not common in a city set up but are common in the rural areas. The range of injuries varies from abdominal, chest, scrotal injuries which are quite different from the usual injuries seen in the emergency and casualty like road traffic injuries and stab injuries. We report a rare case of bull gore injury seen in a 38-year-old farmer, managed in this peripheral mission hospital one involving a stray domestic bull, its management as well as review of the literature. It is aimed that the knowledge gained from analyses of these injuries may be beneficial to other clinicians in general and also applicable to the management of similar injuries sustained in rodeo or agricultural settings. Case Presentation: A 38-year-old male farmer of Kumbo origin, Northwestern Cameroon was seen at the emergency department after being hit by a stray domestic bull in his farm. He presented with a complaint of pain in the left iliac fossa, actively bleeding deep laceration in the left inguinal region and a left scrotal swelling. On presentation, his vital parameters (blood pressure: 120/80 mmHg, pulse rate: 82/minute, respiratory rate: 18/minute, temperature: 37.10 Celcius) were stable. On physical examination, the eviscerated left testes and cord was visible at the edge of a deep laceration in the left inguinal region and there was moderate swelling in the left iliac fossa. Rectal examination did not reveal additional finding. The bowel sounds were normal. We made a clinical diagnosis of penetrating abdominal injury with evisceration of left testes. The findings from the initial laboratory studies; Chest and plain abdomen radiographs were essentially normal. Focused abdominal sonography for trauma showed minimal free fluid in the left paracolic gutter and pelvis as well as diffuse hypoechoic mass (hematoma) of anterior abdominal wall essentially in the left iliac fossa. He was resuscitated on intravenous fluids, IV Ceftriaxone 1gm 12hourly, IV Metronidazole 500mg 8hourly, IV Paracetamol 1gm 8hourly. He also had anti-tetanus prophylaxis and was thereafter transferred to the OR. He had exploratory laparotomy, and left groin exploration; extensive left groin wound debridement with evacuation of hemoperitoneum, orchidopexy and wound closure over left pelvic as well as scrotal drains. The post-operative period was uneventful with optimal recovery. The patient was subsequently discharged on the seventh post-operative day and had since been seen in the surgical outpatient clinic at three weekly intervals for six months with satisfactory outcome. Conclusion: Trauma due to animals especially those caused by bull horn could be life threatening as well as leave disability due to the site involvement. Early intervention and trauma surgery can be both lifesaving and could also prevent disability at a later stage. Management of bull gore injury can be challenging to the surgeon who needs have high index of suspicion for the diagnosis of this condition and take a call on type of management. Also, surgical repair of the injury is also difficult because of the complex anatomy and the less accessibility. There is an increasing priority for preventive measures to curtail such mishaps. Keywords: Bull horn Injury; Abdominal Trauma; Bull-Fight; Goring; Evisceration