Small bowel entrapment following a pelvic fracture

Trauma ◽  
2020 ◽  
pp. 146040862095015
Author(s):  
Saklain Farooq ◽  
Ian Ewington ◽  
Thomas D Pinkney ◽  
Randeep Mullhi
Keyword(s):  
Small Bowel ◽  
Pelvic Fracture ◽  
High Mortality ◽  
Acetabular Fracture ◽  
Severe Pain ◽  
Road Traffic ◽  
Pelvic Fractures ◽  
Mortality And Morbidity ◽  
Road Traffic Collision ◽  
Bowel Herniation

Pelvic fractures are associated with a high mortality and morbidity. Injuries to the bladder and urethra are relatively common whereas bowel trauma is rare. We present a case of acetabular fracture associated with bowel herniation in a 33 year old female who was involved in a road traffic collision. The patient was in severe pain from her acetabular fracture which made diagnosis more difficult due to this distracting injury.

Long-term outcomes of major trauma with unstable open pelvic fractures: A population-based cohort study

Trauma ◽  
2020 ◽  
pp. 146040862093320
Author(s):  
Belinda J Gabbe ◽  
Ian Stewart ◽  
William Veitch ◽  
Ben Beck ◽  
Peter Cameron ◽  
...  
Keyword(s):  
Health Status ◽  
Hospital Mortality ◽  
Pelvic Fracture ◽  
Major Trauma ◽  
Road Traffic ◽  
Population Based ◽  
Pelvic Fractures ◽  
Pelvic Injury ◽  
Trauma Patients ◽  
Post Injury

Aims The aims of this study were to describe the profile and longer-term outcomes of major trauma patients with unstable open pelvic fractures. Patients and methods An observational study was performed using data from the population-based Victorian State Trauma Registry. Adult (≥16 years) major trauma patients who had sustained an unstable open pelvic fracture between 1 July 2010 and 30 June 2017 in Victoria (Australia) were included. Patient demographics, injury event, severity and management data were extracted. Patients were followed up at 6, 12 and 24 months post-injury to collect information about health status, function and return to work. Results There were 67 patients. The mean (SD) age was 41.4 (18.3) years, and 66% were male. Seventy-six per cent were road traffic injuries, 96% were managed at Level 1 trauma centres and all were multi-trauma patients. A third were Tile C fractures and 80% underwent surgical stabilisation of the pelvic injury. Eighty per cent were admitted to intensive care. The in-hospital mortality rate was 9%. Most (89%) survivors were discharged to an inpatient rehabilitation facility. The proportion classified as ‘severe disability’ on the Glasgow Outcome-Scale Extended declined from 38% at 6 months to 19% at 24 months. The overall three-level EuroQoL five-dimensional instrument score increased with time indicating better health status, and 50% of patients returned to work by 24 months. Conclusions Major trauma with unstable, open pelvic fracture is rare. Low in-hospital mortality was observed. Most survived to hospital discharge and outcomes improved with time post-injury, but 75% of patients experienced persistent pain and ongoing mobility and activity restrictions.

629 Small Bowel Entrapment Secondary to An Acetabular Fracture: A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J East ◽  
C Nzekwue ◽  
R Karthikeyan
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Acetabular Fracture ◽  
Rare Complication ◽  
Primary Anastomosis ◽  
High Energy ◽  
Pelvic Fractures ◽  
Emergency Laparotomy ◽  
Diagnostic Challenge ◽  
Acetabular Fragment

Abstract Bowel entrapment within a pelvic fracture is a rare clinical occurrence. The first reported case was documented in 1907, with only 24 further cases reported in the literature since. Entrapment usually involves mobile segments of bowel and various fracture sites within the pelvis have been implicated. We report a case of a 31-year-old ‘trauma alert’, who sustained pelvic fractures following a pedestrian vs car ‘RTC’. The patient was initially taken to theatre for an examination under anaesthesia, where an immobile acetabular fragment was identified, but the hip joint was felt to be stable. A Denham pin was placed in the distal femur and traction applied. Two days post admission they developed abdominal pain and vomiting. A subsequent CT scan demonstrated small bowel entrapment within the acetabular fracture causing a mechanical obstruction. Emergency laparotomy confirmed an intra-acetabular hernia which was released via an extra-peritoneal route. A section of necrotic bowel was resected, and a primary anastomosis performed. Bowel entrapment poses a difficult diagnostic challenge and there is often a delay in diagnosis. Despite advances in imaging, initial radiographic features can be subtle, and it can be difficult to distinguish clinically between mechanical bowel obstruction and adynamic ileus. This case highlights that bowel entrapment is an important consideration in patients with pelvic fractures following high energy trauma. Awareness of this rare complication and a high index of suspicion are key to early diagnosis and timely surgical intervention, which has the potential to prevent significant complications including bowel obstruction, acute peritonitis and death.

scholarly journals Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

2021 ◽  
Author(s):  
Giuseppe Rovere ◽  
Andrea Perna ◽  
Luigi Meccariello ◽  
Domenico De Mauro ◽  
Alessandro Smimmo ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Function ◽  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Sexual Dysfunctions ◽  
Fracture Type ◽  
Ring Fracture ◽  
Male And Female ◽  
Pelvic Ring Injuries

Abstract Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

scholarly journals Recurrence hernia in the broad ligament of the uterus: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Yoshifumi Hashimoto ◽  
Tatsuo Kanda ◽  
Tadasu Chida ◽  
Kazuyoshi Suda
Keyword(s):  
Small Bowel ◽  
Rare Disease ◽  
Broad Ligament ◽  
Significant Risk ◽  
Disease Recurrence ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Bowel Segments ◽  
Hernia Orifice ◽  
Bowel Herniation

Abstract Background Bowel herniation through a defect in the broad ligament of the uterus is a rare disease and few cases of recurrence have been reported. We report herein a recurrence case of a patient with broad ligament hernia (BLH), along with a review of the literature. Case presentation A 53-year-old woman complaining of abdominal pain was transported to our hospital. She had a history of laparotomy for small-bowel obstruction associated with hernia in the broad ligament of the uterus 10 years ago at a local hospital. Abdominal pelvic contrast-enhanced computed tomography revealed that the mesentery of the dilated bowels converged at a thick band in the pelvis, suggesting closed loop obstruction of the small bowel. The patient underwent urgent laparotomy and was diagnosed with bowel herniation through an opening in the broad ligament of the uterus on the right side, which was ipsilateral with the previous surgery. The hernia orifice was widened by incision and incarcerated bowel segments were released and preserved because ischemia was reversible. The membranous defect of BLH was closed by suture with braded silk strings. Conclusions Although BLH is a rare disease, patients face a significant risk of disease recurrence. Nonabsorbable suture may be advisable for closure of the hernia orifice in BLH.

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

scholarly journals Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 204
Author(s):  
Giedrius Petryla ◽  
Valentinas Uvarovas ◽  
Rokas Bobina ◽  
Jaunius Kurtinaitis ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Fracture ◽  
Functional Outcomes ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Posterior Pelvic Ring ◽  
Sf 36 ◽  
One Year ◽  
Anterior Posterior

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

scholarly journals Laparoscopic repair of a small bowel herniation through a broad ligament defect

2014 ◽  
Vol 10 (3) ◽  
pp. 166
Author(s):  
Agustin Buero ◽  
EzequielA. Silberman ◽  
Pablo Medina ◽  
MatiasE. Morra ◽  
DiegoJ. Bogetti ◽  
...  
Keyword(s):  
Small Bowel ◽  
Laparoscopic Repair ◽  
Broad Ligament ◽  
Bowel Herniation ◽  
Broad Ligament Defect

Mortality and morbidity costs of road traffic-based air pollution in Turkey

2021 ◽  
Vol 22 ◽  
pp. 101142
Author(s):  
Shihomi Ara Aksoy ◽  
Anna Kiziltan ◽  
Mustafa Kiziltan ◽  
Merih Aydınalp Köksal ◽  
Fatma Öztürk ◽  
...  
Keyword(s):  
Air Pollution ◽  
Road Traffic ◽  
Mortality And Morbidity

scholarly journals Traumatic Urethral Injury without Pelvic Fracture in an Adult Female

2010 ◽  
Vol 10 ◽  
pp. 308-310 ◽  
Author(s):  
Nathan A. Bockholt ◽  
Kenneth G. Nepple ◽  
Charles R. Powell ◽  
Karl J. Kreder
Keyword(s):  
Adult Female ◽  
Pelvic Fracture ◽  
Acetabular Fracture ◽  
Bladder Neck ◽  
Motor Vehicle ◽  
Urethral Catheter ◽  
Urethral Injury ◽  
Rare Occurrence ◽  
Urethral Meatus ◽  
Vehicle Collision

A 23-year-old female was involved in a motor vehicle collision with multiple injuries, including a right acetabular fracture, but no pelvic fracture. Urology consultation was obtained due to difficulty placing a urethral catheter. Examination revealed a longitudinal urethral tear with vaginal laceration extending 2 cm from the urethral meatus proximally toward the bladder neck. The longitudinal urethral tear was repaired primarily. Traumatic female urethral injury in the absence of a pelvic fracture is an exceedingly rare occurrence.

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