Massive abdominal wall hematoma following a dog bite: a case report.

Introduction and importance: Dog bite injuries are a major global public health concern, predominantly affecting the extremities. Abdominal wall involvement is rare and underreported. This case demonstrates a significant soft tissue hematoma following a dog bite, underscoring the importance of early imaging and surgical intervention even in the absence of coagulopathy. Case presentation: A 47-year-old obese female presented with progressive left-sided abdominal pain and bruising, 6 days post-dog bite to the left iliac fossa. Examination revealed localized ecchymosis and active bleeding, without systemic signs of infection. Contrast-enhanced CT revealed a 4.7 × 10.8 × 8.9 cm hematoma in the subcutaneous plane of the oblique abdominal muscles. The hematoma was aspirated, and necrotic tissue was debrided. The patient received tetanus prophylaxis and broad-spectrum antibiotics, with favorable postoperative recovery. Clinical discussion: Abdominal wall hematomas from dog bites are rare and may be misdiagnosed due to atypical presentation. In this case, timely CT imaging enabled prompt diagnosis and prevented complications such as compartment syndrome or abscess formation. The absence of anticoagulant use or bleeding disorders confirmed trauma as the etiology. Given the polymicrobial nature of dog saliva, empirical antibiotics were essential to prevent secondary infection. Conclusion: This case highlights the potential for severe abdominal wall injuries from dog bites. It emphasizes the significance of timely surgical intervention and the diagnostic use of CT imaging. Clinicians should include abdominal wall hematoma in the differential diagnosis for patients with localized abdominal pain and bruising after a dog bite, even without typical risk factors.