Behind the fracture: An unusual suspect of mechanical bowel.

Abstract

Polytrauma with associated pelvic fractures involves significant morbidity and mortality. If they are linked with injuries involving other systems within the body, the order of morbidity and mortality rises severalfold. Isolated pelvic fractures due to trauma are rare and their association with bowel injury is even rarer. Our case, a traumatic pelvic fracture resulting in ileal obstruction due to herniation and entrapment at the fracture site, is one of these rare cases. This case may also be considered as a Traumatic Abdominal Wall Hernia (TAWH) - essentially the herniation of bowel secondary to abdominal trauma - an entity first coined in 1906. If so, our case qualifies as the 21st such case in recorded history. Low-energy force is sufficient to cause pelvic fractures in the elderly population while high-energy forces are required for similar conditions among younger patients. Thus, the multitude of risk factors that determine falls in the elderly population have to be minimized as even a small mishap may result in something grave. Damage Control Surgery was performed. Our patient's entrapped bowel was reduced and the same area was fashioned into a double-barrel ileostomy. While the protocol to be followed in cases of bowel involvement is uncomplicated, the dilemma that exists is whether to subject the patient to operative intervention or adopt a conservative approach vis-a-vis the pelvic bone fracture. In cases of isolated pelvic fractures, a non-operative line may be taken, although a significantly higher survival rate has been seen with those undergoing operative intervention.