Abdominal distension 3 days post-high-speed road traffic accident

Abstract

A 38-year-old female suffered a closed head injury and compound pelvic fracture after a high-speed motor vehicle accident. The CT scan on admission revealed unstable compound pelvic fractures, which included a right lateral sacral, bilateral pubic rami and a left sided non-displaced acetabular fracture (Figures 1–2). She had a trace amount of free intraperitoneal fluid. The CT was otherwise considered unremarkable for a solid or hollow visceral injury. Owing to the severity of her head injury, the pelvic fractures were treated conservatively. Over the ensuing days she demonstrated signs of obstruction and, at day 3, a repeat CT for her nausea and abdominal distension was performed (Figure 3) with a working diagnosis of an adynamic ileus. What is the diagnosis?