Recognition of Small Bowel Entrapment in the Pubic Symphysis Following Combat-Related Traumatic Pelvic Fracture: A Case Report and Literature Review.

Abstract

To the best of our knowledge, this report is the first documented case of small bowel entrapment in the pubic symphysis following closed reduction of an APC-III pelvic fracture as a result of a high-energy blast during combat. Our patient is a marine in the United States Marine Corps who had been on a dismounted foot patrol in Afghanistan when he had sustained a substantial blast injury. He had received multiple lifesaving measures downrange, including an exploratory laparotomy with a diverting sigmoid colostomy, pelvic packing, and pelvic external fixation with unsuccessful attempts at closed reduction. A revision of the pelvic external fixation was performed at the final echelon of care with the successful closed reduction of a 4 to 5-cm pubic symphysis diastasis. Repeat exploration of the laparotomy revealed incarcerated small bowel within the pubic symphysis, which required small bowel resection and anastomosis. Fortunately, this case had a favorable outcome with no deficit in small bowel function. Stubbart and Merkley1 have reviewed nineteen cases of various entrapments within the pelvic ring following traumatic injuries, but none have documented small bowel entrapment in the pubic symphysis. Our case describes this rare complication and discusses the implications that associated disruption of the anterior peritoneal wall has on the risk of entrapping small bowel within the pubic symphysis during closed reduction of pelvic fracture. Orthopaedic trauma surgeons should consider direct visualization of the fracture reduction when the integrity of peritoneal injury repair is unknown. The patient was informed that data concerning his case would be submitted for publication, and he provided consent. A twenty-one-year-old active-duty marine in the United States Marine Corps had sustained a devastating blast injury while on foot patrol in support of Operation Enduring Freedom in Afghanistan. Arriving at the Forward Operating Base aid station, the patient’s systolic blood …