Evisceration of intestines with diaphragmatic laceration and gastric perforation secondary to trauma by rhinoceros attack and its management: a case report

Injuries from animal attack are one of the major public health problems at present scenario globally. Proper documentation is required for the study of different types of injuries caused by animal attacks so that early intervention can be done during life-threatening conditions. CASE PRESENTATION: A 36-year-old male presented with an alleged history of attack by two rhinoceros sustaining injuries over the abdomen, chest, shoulder and thigh. CLINICAL FINDINGS AND INVESTIGATIONS: There was a lacerated abdomen with evisceration of the stomach, small intestine, transverse colon and omentum and a lacerated wound over the left lateral thigh and left buttock along with the right shoulder. Extended Focused Assessment with Sonography in Trauma ultrasound showed minimal free fluid in the pelvis. Blood profile revealed reduced haemoglobin and deranged prothrombin time/international normalized ratio. INTERVENTIONS AND OUTCOME: Patient underwent exploratory laparotomy twice with repair of diaphragmatic injury, excision of avulsed greater omentum in the first setting and repair of gastric perforation in the second setting with stable haemodynamic status. CONCLUSION: Abdominal evisceration injury by rhinoceros attack is life threatening though rare. Its management should consist of assessing for and controlling associated haemorrhage, assessing for bowel content leakage, covering the eviscerated abdominal contents and early reduction of viscera if there is no active bleeding.