Small Bowel Obstruction From Entrapment in a Sacral Fracture Stabilized With Iliosacral Screws: Case Report and Review of the Literature

Many high-energy injuries of the pelvic ring involve displacement of both the anterior and posterior bony structures, and displaced fractures of the sacrum are not ail uncommon part of such an injury pattern. Case reports of bowel incarceration in pelvic fractures, especially in sacral fractures, are exceedingly rare in the literature. In most situations, the iliacus and psoas muscles serve as a buffer between the abdominal contents and the posterior pelvic ring injury, thus protecting the peritoneum from injury and preventing the bowel from communicating with the fracture site. We present a case in which a sacral fracture was reduced and subsequently stabilized with two percutaneous iliosacral screws. Many days later, the patient was diagnosed with a small bowel obstruction and, during surgical exploration, a loop of small bowel was found incarcerated in the stabilized sacral fracture. This is the first reported case of this unique complication. The morbidity and mortality associated with this rare condition necessitate that the surgeon maintain a high index of suspicion for it when managing patients with bowel problems after traumatic pelvic injuries.