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Letter to the Editor
Comment on “Sheathed goring: An unusual bull-horn injury”
Comentario a “Cornada envainada: una lesión por asta de toro infrecuente”
Andreu Martínez-Hernándeza,b,
Corresponding author
andmarti@uji.es

Corresponding author.
a Department of General and Visceral Surgery, University General Hospital of Castellon, Spain
b Professor of Medicine, Jaime I University, Castellon, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have reviewed with great interest the manuscript recently published in the journal&#44; <span class="elsevierStyleItalic">Cirug&#237;a Espa&#241;ola</span>&#44; by Ben&#237;tez Riesco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We would like to congratulate the authors on their work and their contribution to the visibility of a rare but sometimes devastating injury in terms of morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Sheathed goring&#44; also known as &#34;goring of the healthy&#34; or &#34;internal goring&#34;&#44; is defined as a subtype of penetrating bull-horn trauma&#44; where&#44; despite the skin remaining intact&#44; there is injury to the deeper structures and tissues&#44; which may be associated with eventrations or vascular and visceral injuries of greater severity&#46; In reality&#44; it is a contained evisceration&#46; This peculiarity of bull-horn trauma is due to the characteristics of the kinematics of the bull&#39;s charge and the high elastic capacity of human skin&#44; maintaining its integrity uninterrupted &#40;this can sometimes be associated with slight superficial alterations&#58; ecchymosis or haematomas&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Few authors in the literature describe this type of trauma&#44; and almost all are descriptions of isolated clinical cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#8211;7</span></a> At the Surgery Dept&#46; of the Hospital General Universitario in Castell&#243;n&#44; we published our experience after undertaking the largest review of bull-horn trauma injuries recorded to date&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our series of 572 patients&#44; we report an incidence of sheathed goring of less than 1&#37; &#40;0&#46;7&#37;&#41;&#46; The 4 affected patients &#40;male&#44; with a mean age of 35 years&#41; had sustained blunt bull-horn trauma at abdominal level with complete skin integrity&#46; All were seen in the emergency department as polytrauma patients&#44; and after primary ATLS &#40;Advanced Trauma Life Support&#41; assessment&#44; a computerised axial tomography &#40;CAT&#41; scan was run and emergency surgery undertaken&#46; In 75&#37; of patients&#44; associated visceral injuries &#40;renal&#44; intestinal and mesenteric injury&#41; were observed&#46; After specific surgical treatment for each type of lesion&#44; primary repair of the abdominal wall was performed&#44; in half of the cases with the placement of a prosthetic mesh&#44; with no differences being observed between the two in terms of subsequent recurrence or infections &#40;0&#37; in both techniques&#41;&#46; The mean hospital stay was 8 days&#44; no patient stayed in the intensive care unit&#44; and the mortality rate was zero&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Thus&#44; although bull-horn injuries are frequent in our environment&#44; the incidence of sheathed goring is extremely low&#46; However&#44; it is important to be aware of and suspect this type of injury in the event of blunt abdominal trauma&#59; to run a systematic primary assessment and an exhaustive physical examination&#44; along with a radiological study &#40;whenever the patient&#39;s stability allows&#41;&#44; preferably a CT scan&#44; to diagnose these cases and rule out associated intra-abdominal injuries&#46; Surgical treatment should be urgent and the repair of the abdominal wall will be determined by the size of the defect&#44; tissue characteristics&#44; haemodynamic stability and level of contamination&#46;</p></span>"
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ISSN: 21735077
Original language: English
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