Vaginal Injury by a Cow's Horn : Journal of Emergencies, Trauma, and Shock

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Letters to Editor

Vaginal Injury by a Cow's Horn

Takeuchi, Ikuto; Muramatsu, Ken-ichi; Ota, Soichiro; Yanagawa, Youichi

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Journal of Emergencies, Trauma, and Shock: Jul–Sep 2022 - Volume 15 - Issue 3 - p 152-153
doi: 10.4103/jets.jets_79_22
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Dear Editor,

An average Japanese cow weighs between 650 and 800 kg. Kicking, crushing, head butting, trampling, accidental stepping, and collision are the main causes of cattle-related injury, with fractures/contusions being the most common consequences, but attacks to the trunk may result in a fatal outcome.[1] Herein, we report a rare case of vaginal injury induced by a cow's horn.

A 35-year-old woman who worked cleaning up a cattle barn as a staff member at an agricultural high school was attacked by a Japanese Black beef cow that weighed 600 kg. During the attack, she suffered head butts to the trunk and was pressed against a woody fence while suffering a horn attack to her perineum. As she complained of abdominal and back pain and had genital bleeding, she was transported to our hospital by ambulance. She had no specific personal or family history. On arrival at our hospital, her vital signs were stable. Enhanced computed tomography (CT) showed a fracture of the left processus transversus at the fourth lumbar and a laceration of the right vaginal wall [Figure 1]. Colposcopy also revealed vaginal wall laceration, but there was no active bleeding from the injured site. She was thus admitted for observation without antibiotics. The postadmission course was uneventful, and she was discharged on foot on day 7.

F1-9
Figure 1:
Enhanced CT on arrival. CT showed laceration of the right vaginal wall (arrow). CT: Computed tomography

There have been no Japanese reports of vaginal injury induced by cattle. Moreover, there have been two case reports and two original articles concerning vaginal injury caused by cow horn injury, similar to our own.[2345] As the vagina is largely protected by the pelvis from blunt impact to the lower abdomen during an animal attack, the vaginal injury might require stabbing by a horn. Previous all cases of vaginal injury were treated by surgical suturing.[2345] In contrast to these findings, our present patient was cured by observation without complications.

The present case of vaginal injury was detected on enhanced CT. To our knowledge, this is the first report to involve the detection of vaginal injury induced by a cow on CT. The main purpose of performing enhanced CT, in this case, was to screen for visceral injuries from the attack to the trunk. Confirming vaginal injury was considered to be achievable with a colposcopic investigation alone. As a blunt attack to the trunk might have resulted in significant visceral injuries in addition to penetrating injury by the horn, enhanced CT was considered useful not only for monitoring the visceral organs but also for detecting vaginal injury in the present case. These unique imaging findings improve our understanding of the radiological details of cattle-related injuries.

Research quality and ethics statement

The authors followed applicable EQUATOR Network (https://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from the Promotion and Mutual Aid Corporation for Private Schools of Japan.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Fraser-Williams AP, McIntyre KM, Westgarth C. Are cattle dangerous to walkers.A scoping review? Inj Prev. 2016;22:437–41
2. Gupta A, Sharma C, Soni A, Gupta B, Thusoo M. Unusual lower genital tract injury caused by bull's horn: Prolapse of small intestine through vagina-first case report in literature Arch Gynecol Obstet. 2012;286:803–4
3. Okur MI, Yildirim AM, Köse R. Severe haematoma of the vulva and defloration caused by goring Eur J Obstet Gynecol Reprod Biol. 2005;119:250–2
4. Habek D, Kulas T. Nonobstetrics vulvovaginal injuries: Mechanism and outcome Arch Gynecol Obstet. 2007;275:93–7
5. Priyadarshi V, Gupta D, Pal DK. Lower genitourinary tract trauma caused by cow horn injury J Obstet Gynaecol India. 2016;66:578–82
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