%0 Journal Article
%T A case of bowel entrapment after penetrating injury of the pelvis: don't forget the omentumplasty
%A Ewan D Ritchie
%A Eelco J Veen
%A Jan Olsman
%A Koop Bosscha
%J Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
%D 2011
%I BioMed Central
%R 10.1186/1757-7241-19-34
%X Bowel entrapment within a pelvic injury is rare and difficult to diagnose. Usually, it is diagnosed late because of concomitant abdominal injuries. It may present itself as an acute intestinal obstruction or, more commonly, as a prolonged or intermittent ileus. Therefore, one should be aware of this late complication and primarily take measures for avoiding bowel entrapment.A twenty-eight year old man was involved in a car crash sustaining a traumatic injury to the lower abdomen. A metal roadwork pole broke and went through the engine and speared the patient. The pole went in at his left groin penetrating his abdomen, and came out on the other side through his sacral bone. (Figure 1) After freeing the patient by cutting the metal pole on both sides, he was transferred to our hospital with the pole in situ. At the emergency department, the patient was examined according to the ATLS principles. The patient had sustained no further damage to the body and was hemodynamically stable. There was no medical or surgical history. There was no neurovascular damage and the function of the perineal region was intact. Trauma radiographs showed the penetrating corpus alienum through the sacral bone. The pelvic ring was intact. A CT scan of the abdomen with contrast confirmed the injury but did not show any bowel or vascular injury (Figure 2).The patient was transferred to the OR and was removed by pulling the pole ventrally without any force. Faecal contamination was diagnosed by exploring the sacral wound. The patient remained hemodynamic stable. An explorative laparotomy was performed and only showed a perforation of the rectosigmoid due to pentrating injury of the pole; a Hartmann's procedure was performed. The central sacral bone defect had a diameter of 2 inches, sparing S1 and S2 foramina and was left untouched. The vascular structures and the urethra were investigated peroperatively, and showed no damage. Postoperatively, the patient went to the ICU. Physical examination po
%U http://www.sjtrem.com/content/19/1/34