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Simultaneous Surgery on Jejunum perforation with Pelvic Ring Fracture: A Case Report

  • Chung, HoeJeong (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University) ;
  • Bae, Keum-Seok (Department of General Surgery, Wonju College of Medicine, Yonsei University) ;
  • Kim, Seong-yup (Department of General Surgery, Wonju College of Medicine, Yonsei University) ;
  • Kim, Doosup (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University)
  • Received : 2016.05.21
  • Accepted : 2016.07.04
  • Published : 2016.06.30

Abstract

Patients with pelvic bone fractures with gastrointestinal perforations are reported in 4.4% of the cases and in very rare cases jejunum (0.15) is involved. However, intestinal perforations are often undiagnosed on the first examination before peritonitis is evident. We are presenting a report where a patient with anteroposterior compression injury, who was expected to undergo an internal fixation procedure, did not show any jejunum perforations on abdominal CT or other physical exams but was found on abdominal CT 1 week after right before surgery, therefore excision and anastomosis surgery, pelvic open reduction and internal fixation was simultaneously done with favorable results. In our case, we present a 61 year old male patient with liver trauma, adhesion at the abdominal cavity, with a past history of gallbladder excision, but without abdominal pain, fever, or infection symptoms. Therefore, this was a case that was difficult to initially diagnose the patient with jejunum perforation and peritonitis. The diagnosis was further supported during laparotomy when peritonitis around the area of intestinal perforation was observed. Generally, it is understood that pelvic bone fracture surgery is not immediately done on patients with peritonitis. However, this kind of patient who had peritonitis with intestinal adhesion and other complications could undergo surgery immediately as infection or other related symptoms did not coexist and the patient was rather stable, and as a result the treatment was successful.

Keywords

References

  1. Schmal H, Markmiller M, Mehlhorn AT, Sudkamp NP. Epidemiology and outcome of complex pelvic injury. Acta Orthop Belg. 2005; 71: 41-7.
  2. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002; 195: 1-10. https://doi.org/10.1016/S1072-7515(02)01197-3
  3. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg 1988; 70: 1-12. https://doi.org/10.2106/00004623-198870010-00001
  4. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986; 160: 445-51. https://doi.org/10.1148/radiology.160.2.3726125
  5. Min BW, Lee KJ, Kim GW, Kwon DH. Complications of Pelvic Ring Injury. J Kor Fracture Soc 2013; 26: 348-53. https://doi.org/10.12671/jkfs.2013.26.4.348
  6. Balogh Z, Caldwell E, Heetveld M, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference?: J trauma 2005; 58: 778-82. https://doi.org/10.1097/01.TA.0000158251.40760.B2
  7. Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma. 2007; 62: 834-9; discussion 839-42. https://doi.org/10.1097/TA.0b013e31803c7632
  8. van Vugt AB1, van Kampen A. An unstable pelvic ring. The killing fracture. J Bone Joint Surg Br. 2006; 88: 427-33.
  9. Goudar BV, Ambi U, Lamani Y, Telkar S. Single jejunal blowout perforation following blunt abdominal trauma: Diagnostic dilemma Journal of Clinical and Diagnostic Research. 2011; 5: 1120-2.