Small Bowel Entrapment Following Pelvic Fracture: A Case Report
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Abstract
Background: Due to traumatic events, patients with acetabular fractures are vulnerable to rupture of the peritoneum and abdominal hernia in the fracture site. Infection and thromboembolic events are the two most common complications of this situation.
Case Report: In the current report, we present a 63 year-old woman with a traffic accident that was diagnosed with multiple fractures of posterior and anterior walls and anterior column of the right acetabulum associated with femoral head protrusion to the fracture site. Furthermore, the right posterior iliac wing fracture and mild subluxation of the right sacroiliac (SI) joint were observed in the pelvic computed tomography (CT) scan. During the Stoppa surgical approach, small intestine penetration and peritoneum were observed and immediately treated by the surgical team. Our case was later diagnosed with pulmonary thromboembolism and recovered successfully, and no infectious complications were observed.
Conclusion: We suggest that bowel entrapment be considered in blunt traumatic events, and antibiotics and anti-coagulants be used in similar cases.
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5. Scolari Childress KM, Gavard JA, Ward DG, Berger K, Gross GA. A barrier retractor to reduce surgical site infections and wound disruptions in obese patients undergoing cesarean delivery: a randomized controlled trial. Am J Obstet Gynecol. 2016;214(2):285. doi: 10.1016/j.ajog.2015.09.096. [PubMed: 26440690].
6. Walcher F, Rose S, Roth R, Lindemann W, Mutschler W, Marzi I. Double traumatic abdominal wall hernia and colon laceration due to a pelvic fracture. Injury. 2000;31(4):253-6. doi: 10.1016/s0020-1383(99)00295-8. [PubMed: 10719105].
7. Hall EG, Fleming CME, Griffis ECE, Strauss CJ, Andersen CR. Recognition of small bowel entrapment in the pubic symphysis following combat-related traumatic pelvic fracture: A case report and literature review. JBJS Case Connect. 2012;2(1):e13. doi: 10.2106/JBJS.CC.K.00093. [PubMed: 29252464].
8. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;(305):112-23. [PubMed: 8050220].
9. Meena S, Sharma PK, Mittal S, Sharma J, Chowdhury B. Modified Stoppa approach versus ilioinguinal approach for anterior acetabular fractures; a systematic review and meta-analysis. Bull Emerg Trauma. 2017;5(1):6-12. Retrieved from. [PubMed: 28246617 PMC5316130].
10. Tanaka R, Nagahara H, Maeda K, Ohtani H, Shibutani M, Tamura T, et al. A case of bowel perforation due to traumatic hernia at a pelvic fracture site: A case report and review of the literature. BMC Surg. 2017;17(1):81. doi: 10.1186/s12893-017-0278-y. [PubMed: 28701197]. [PubMed Central: PMC5508791].
11. Delaune L, Steinmetz S, Heutschi-Ozturk H, Borens O. Traumatic abdominal wall hernias: Disruptions of the abdominal wall muscles associated to pelvic bone fractures illustrated by two case reports. BMC Surg. 2020;20(1):253. doi: 10.1186/s12893-020-00909-2. [PubMed: 33109131]. [PubMed Central: PMC7590667].
12. Morris BJ, Unger RZ, Archer KR, Mathis SL, Perdue AM, Obremskey WT. Risk factors of infection after ORIF of bicondylar tibial plateau fractures. J Orthop Trauma. 2013;27(9):e196-e200. doi: 10.1097/BOT.0b013e318284704e. [PubMed: 23287757].
13. Niikura T, Lee SY, Oe K, Koh A, Koga T, Dogaki Y, et al. Incidence of venous thromboembolism in pelvic and acetabular fractures in the Japanese population. J Orthop Sci. 2012;17(3):233-8. doi: 10.1007/s00776-012-0203-2. [PubMed: 22453360].
14. Paydar S, Sabetian G, Khalili H, Fallahi J, Tahami M, Ziaian B, et al. Management of deep vein thrombosis (DVT) prophylaxis in trauma patients. Bull Emerg Trauma. 2016;4(1):1-7. Retrieved from. [PubMed: 27162921]. [PubMed Central: PMC4779464].
15. JCS Joint Working Group. Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J. 2011;75(5):1258-81. doi: 10.1253/circj.cj-88-0010. [PubMed: 21441695].
16. Velazquez N, Fantus RJ, Fantus RJ, Kingsley S, Bjurlin MA. Blunt trauma pelvic fracture-associated genitourinary and concomitant lower gastrointestinal injury: incidence, morbidity, and mortality. World J Urol. 2020;38(1):231-8. doi: 10.1007/s00345-019-02725-7. [PubMed: 30929048].
17. Westberg S, Kupfer N, Fung C, Widder S, Glasgow D. Small bowel obstruction secondary to entrapment in a minimally displaced acetabular fracture: A case report. JBJS Case Connect. 2019;9(2):e0222. doi: 10.2106/JBJS.CC.18.00222. [PubMed: 31233427].
2. Bushnell BD, Dirschl DR. Small bowel obstruction from entrapment in a sacral fracture stabilized with iliosacral screws: Case report and review of the literature. J Trauma. 2008;65(4):933-7. doi: 10.1097/01.ta.0000197857.26410.16. [PubMed: 18288016].
3. Hoffberg JE, Koenigshof AM, Guiot LP. Retrospective evaluation of concurrent intra-abdominal injuries in dogs with traumatic pelvic fractures: 83 cases (2008-2013). J Vet Emerg Crit Care (San Antonio). 2016;26(2):288-94. doi: 10.1111/vec.12430. [PubMed: 26754578].
4. Yang NP, Chan CL, Chu D, Lin YZ, Lin KB, Yu CS, et al. Epidemiology of hospitalized traumatic pelvic fractures and their combined injuries in Taiwan: 2000-2011 National Health Insurance data surveillance. Biomed Res Int. 2014;2014:878601. doi: 10.1155/2014/878601. [PubMed: 24804258]. [PubMed Central: PMC3988716].
5. Scolari Childress KM, Gavard JA, Ward DG, Berger K, Gross GA. A barrier retractor to reduce surgical site infections and wound disruptions in obese patients undergoing cesarean delivery: a randomized controlled trial. Am J Obstet Gynecol. 2016;214(2):285. doi: 10.1016/j.ajog.2015.09.096. [PubMed: 26440690].
6. Walcher F, Rose S, Roth R, Lindemann W, Mutschler W, Marzi I. Double traumatic abdominal wall hernia and colon laceration due to a pelvic fracture. Injury. 2000;31(4):253-6. doi: 10.1016/s0020-1383(99)00295-8. [PubMed: 10719105].
7. Hall EG, Fleming CME, Griffis ECE, Strauss CJ, Andersen CR. Recognition of small bowel entrapment in the pubic symphysis following combat-related traumatic pelvic fracture: A case report and literature review. JBJS Case Connect. 2012;2(1):e13. doi: 10.2106/JBJS.CC.K.00093. [PubMed: 29252464].
8. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;(305):112-23. [PubMed: 8050220].
9. Meena S, Sharma PK, Mittal S, Sharma J, Chowdhury B. Modified Stoppa approach versus ilioinguinal approach for anterior acetabular fractures; a systematic review and meta-analysis. Bull Emerg Trauma. 2017;5(1):6-12. Retrieved from. [PubMed: 28246617 PMC5316130].
10. Tanaka R, Nagahara H, Maeda K, Ohtani H, Shibutani M, Tamura T, et al. A case of bowel perforation due to traumatic hernia at a pelvic fracture site: A case report and review of the literature. BMC Surg. 2017;17(1):81. doi: 10.1186/s12893-017-0278-y. [PubMed: 28701197]. [PubMed Central: PMC5508791].
11. Delaune L, Steinmetz S, Heutschi-Ozturk H, Borens O. Traumatic abdominal wall hernias: Disruptions of the abdominal wall muscles associated to pelvic bone fractures illustrated by two case reports. BMC Surg. 2020;20(1):253. doi: 10.1186/s12893-020-00909-2. [PubMed: 33109131]. [PubMed Central: PMC7590667].
12. Morris BJ, Unger RZ, Archer KR, Mathis SL, Perdue AM, Obremskey WT. Risk factors of infection after ORIF of bicondylar tibial plateau fractures. J Orthop Trauma. 2013;27(9):e196-e200. doi: 10.1097/BOT.0b013e318284704e. [PubMed: 23287757].
13. Niikura T, Lee SY, Oe K, Koh A, Koga T, Dogaki Y, et al. Incidence of venous thromboembolism in pelvic and acetabular fractures in the Japanese population. J Orthop Sci. 2012;17(3):233-8. doi: 10.1007/s00776-012-0203-2. [PubMed: 22453360].
14. Paydar S, Sabetian G, Khalili H, Fallahi J, Tahami M, Ziaian B, et al. Management of deep vein thrombosis (DVT) prophylaxis in trauma patients. Bull Emerg Trauma. 2016;4(1):1-7. Retrieved from. [PubMed: 27162921]. [PubMed Central: PMC4779464].
15. JCS Joint Working Group. Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J. 2011;75(5):1258-81. doi: 10.1253/circj.cj-88-0010. [PubMed: 21441695].
16. Velazquez N, Fantus RJ, Fantus RJ, Kingsley S, Bjurlin MA. Blunt trauma pelvic fracture-associated genitourinary and concomitant lower gastrointestinal injury: incidence, morbidity, and mortality. World J Urol. 2020;38(1):231-8. doi: 10.1007/s00345-019-02725-7. [PubMed: 30929048].
17. Westberg S, Kupfer N, Fung C, Widder S, Glasgow D. Small bowel obstruction secondary to entrapment in a minimally displaced acetabular fracture: A case report. JBJS Case Connect. 2019;9(2):e0222. doi: 10.2106/JBJS.CC.18.00222. [PubMed: 31233427].
| Files | ||
| Issue | Vol 8, No 1 (2022) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v8i1.9044 | |
| Keywords | ||
| Intestines Wounds and Injuries Pelvis | ||
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How to Cite
1.
Ravanbod H, Hatami S, Shahsavan M, Naderi Boldaji H, Zand F. Small Bowel Entrapment Following Pelvic Fracture: A Case Report. J Orthop Spine Trauma. 2022;8(1):33-5.
