Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures
A 51-year-old man, with no medical history of note, was in a motorcycle accident. In the emergency room, he presented with hemodynamic instability due to a pelvic fracture and a concomitant catastrophic soft tissue injury involving the scrotum, perineum, and anus with absence of the anal reflex. The extended EcoFast showed no fluid collection in the abdomen and no pneumothorax. The pelvis X-ray showed ischiopubic and ileopubic fractures associated with symphyseal disruption (anterior posterior fracture APII, see Young and Burgess). After the resuscitation phase, the patient underwent full-body computed tomography (CT) [] and was subsequently transferred to the operating theater. His pelvis was fixed with external screws [].\nAn exploratory laparotomy was performed to exclude abdominal organ damage, and a loop colostomy was performed for the anal incompetence. Then, the patient was admitted to our intensive care unit (ICU), where no bowel function was observed for the first 6 post-operative (PO) days. On PO day 7, the patient presented with abdominal distension, elevated inflammatory indices, and fever, so we performed abdominal CT with oral and intravenous contrast looking for signs of intestinal obstruction.\nThe clinical hypothesis of obstruction was confirmed by the presence of numerous dilated small bowel loops with air/fluid levels; CT showed an ileum segment trapped in the sacral fracture [].\nThe patient underwent an exploratory laparotomy that confirmed the cause of the obstruction; a small bowel resection and an end-to-end manual anastomosis were thus performed.\nThe second post-operative period was uneventful, and the patient was discharged from the ICU to a ward. An evaluation of the rectal sphincter showed normal function; therefore, after the peroneal wound healed, the colostomy was closed.