CASE 13019 Published on 11.10.2015

Sheathed goring: an unusual mechanism of trauma

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Luis Gijón de la Santa, Irene Méndez Mesón, José Antonio Pérez Retortillo, Ainhoa Camarero Miguel, Lidia Nicolás Liza, José Manuel Ramia Ángel.

Hospital Universitario de Guadalajara
C/Donantes de Sangre S/N
19004, Guadalajara (Spain)
E-mail:luigigijon@gmail.com
Patient

75 years, male

Categories
Area of Interest Abdomen ; Imaging Technique CT
Clinical History
A 75-year-old patient was brought to the emergency room with thoracic and abdominal trauma. He had been watching the running of the bulls (in Spanish: encierro) and a bull had hit him. The patient was haemodynamically stable and presented multiple contusions. MDCT was performed because of the high-impact trauma.
Imaging Findings
MDCT showed an abdominal wall hernia without entrance wound on the skin because of the bull horn impact (Fig. 1a).
A severe mesenteric fat stranding due to the mesenteric trauma, haemoperitoneum and several active bleeding points were also revealed (Fig. 1a-c).
Another imaging findings included multiple rib fractures due to the thoracic trauma (Fig. 1d).
Discussion
Running of the bulls is the tradition of running in front of a small group of cattle in the town or countryside. These events attract lots of people and lately have been exported to several countries.
It is a dangerous activity with a lot of potential life-threatening lesions such as gorings, contusions, fractures or vascular injury.
These injuries have special characteristics that distinguish them from all other lesions due to the aggressor agent and the biomechanics of gorings. A bull weighs an average of 500 kg (1102 lb), reaches a speed of 35 km/h (21.75 mph) and can cause a high-impact trauma. Gorings combine penetrating and blunt trauma.
There is a special type of bull horn wound called sheathed goring. It is a penetrating wound without skin defect (entry wound). In this lesion the skin, due to its elastic capacity, returns to its normal appearance after the goring. Skin ecchymosis or soft tissues haematoma can also be seen [1-3].
This type of goring can be underestimated during the clinical examination mimicking a superficial lesion and can have a poor prognosis due to the internal damage, hence it is crucial to be aware of this possibility [1-3].

It is important to remark that there is no radiologic literature about these peculiar lesions.
Differential Diagnosis List
Sheathed goring with abdominal wall hernia and mesenteric trauma.
Blunt trauma
Penetrating trauma
Final Diagnosis
Sheathed goring with abdominal wall hernia and mesenteric trauma.
Case information
URL: https://www.eurorad.org/case/13019
DOI: 10.1594/EURORAD/CASE.13019
ISSN: 1563-4086
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