Colon perforation from an uncommon cause: a case report
Abstract
Pelvic fractures are frequently associated with concomitant injuries to intra-abdominal and genitourinary structures. We report an unusual case of colonic perforation secondary to entrapment of the sigmoid colon within a complex pelvic fracture. A 59-year-old male sustained a high-energy blunt trauma following a motor vehicle rollover. Upon presentation to the Emergency Department, he was responding with an intact airway and hemodynamically normal and stable. Auscultation revealed normal and symmetrical breath sounds bilaterally (SpO2 98%). The patient was alert, oriented, and scored 15/15 on the Glasgow Coma Scale. Physical examination revealed pelvic instability. Whole-body computed tomography (CT) demonstrated an anteroposterior compression (APC) Type III pelvic ring injury with herniation and perforation of the sigmoid colon into the fracture site, accompanied by free air. The patient underwent emergency exploratory laparotomy, which confirmed the diagnosis. A sigmoidectomy with Hartmann’s procedure was performed. Definitive pelvic stabilization was achieved in a subsequent operative session. Incarceration of bowel loops within pelvic fractures is exceedingly rare but represents a surgical emergency due to the risk of fulminant sepsis and mortality. Early radiologic identification and prompt surgical management are imperative. A high index of suspicion is warranted in patients with complex pelvic fractures, particularly in the presence of free intraperitoneal air or signs of peritonitis.
References
- Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg 2017;12:5. DOI: https://doi.org/10.1186/s13017-017-0117-6
- Westberg S, Kupfer N, Fung C, et al. Small Bowel Obstruction Secondary to Entrapment in a Minimally Displaced Acetabular Fracture: A Case Report. JBJS Case Connect 2019;9:e0222. DOI: https://doi.org/10.2106/JBJS.CC.18.00222
- Zong ZW, Bao QW, Liu HY, et al. Diagnosis and treatment of rare complications of pelvic fractures. Chin J Traumatol 2016;19:199-205. DOI: https://doi.org/10.1016/j.cjtee.2015.12.012
- Lin PS, Cavarocchi NC, Comerota AJ, Resnick EJ. Acute bowel entrapment and perforation following operative reduction of pelvic fracture. J Trauma 1987;27:684-6. DOI: https://doi.org/10.1097/00005373-198706000-00018
- Farooq S, Ewington I, Pinkney TD, Mullhi R. Small bowel entrapment following a pelvic fracture. Trauma 2020;23:153-6. DOI: https://doi.org/10.1177/1460408620950154
- Derian PS, Purser T 3rd. Intra-articular small-bowel herniation complicating central fracture-dislocation of the hip. J Bone Joint Surg Am 1966;48:1614-21. DOI: https://doi.org/10.2106/00004623-196648080-00018
- Poilly JN, Hamilton JB. Central dislocation of the hip causing mechanical intestinal obstruction. Injury 1974;5:194-6. DOI: https://doi.org/10.1016/S0020-1383(74)80004-5
- Tanaka R, Nagahara H, Maeda K, 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;17:81. DOI: https://doi.org/10.1186/s12893-017-0278-y
- Catsikis BD, French WM, Norcus G, et al. CT diagnosis of bowel herniation at pelvic fracture site. J Comput Assist Tomogr 1989;13:148-9. DOI: https://doi.org/10.1097/00004728-198901000-00037
- Stubbart JR, Merkley M. Bowel entrapment within pelvic fractures: a case report and review of the literature. J Orthop Trauma 1999;13:145-8. DOI: https://doi.org/10.1097/00005131-199902000-00014
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