Anastomotic Dehiscence Secondary to Early Eventration in Abdominal Trauma Caused by a Bull Horn: The Critical Importance of Abdominal Wall Integrity

Abdominal trauma caused by a bull horn is a rare but severe injury that can lead to multiple intestinal perforations and life-threatening complications. This case report highlights the critical management challenges and emphasizes the importance of multidisciplinary care in a high-risk surgical patient. A 36-year-old male presented with open abdominal trauma and small bowel evisceration following a bull horn injury. An initial exploratory laparotomy revealed three perforations in the ileum, requiring a 30 cm resection and end-to-end anastomosis. Postoperatively, he was managed in the intensive care unit due to the severity of the trauma. On postoperative day two, he developed signs of intestinal obstruction and underwent a second exploratory laparotomy. Intraoperative findings revealed ileal eventration through the previous penetrating wound, resulting in partial dehiscence of a single suture at the mesenteric border of the anastomosis. To our knowledge, this is one of the few documented cases in which early eventration directly led to anastomotic dehiscence following bull horn trauma. The anastomosis was reconstructed, and the abdominal wall was reinforced. The postoperative course was complicated by acute kidney injury, which improved with fluid resuscitation and withdrawal of nephrotoxic agents. The patient was discharged on postoperative day twelve with oral antibiotics and scheduled outpatient follow-up. This case illustrates a rare but severe complication following high-energy penetrating trauma and underscores the critical importance of considering damage control surgery in cases with extensive contamination. The favorable outcome highlights that maintaining a high index of suspicion for complications, early re-intervention, meticulous surgical technique, and coordinated multidisciplinary management are key to successful outcomes in complex abdominal trauma.