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Entrapment of intestine in pelvic fracture — Clinical Guidelines

Overview

Entrapment of intestine in pelvic fractures refers to bowel incarceration within pelvic fracture hematoma or surgical sites, complicating the management of pelvic injuries and potentially leading to bowel ischemia or necrosis. This condition requires prompt recognition and intervention to prevent severe morbidity and mortality 10 27.

Diagnosis

Clinical Presentation: Abdominal pain, distension, and signs of peritonitis alongside pelvic fracture symptoms.

Imaging: CT scans are crucial for identifying bowel entrapment, hematoma formation, and associated fractures 10 27.

Laboratory Tests: Elevated inflammatory markers and coagulation profiles may indicate ongoing hemorrhage or organ dysfunction 1 16.

Management

Initial Stabilization: Focus on hemodynamic stabilization, including fluid resuscitation and control of hemorrhage 1 10 15.

Surgical Intervention: Definitive surgical exploration and decompression of entrapped bowel are often necessary 10 27.

Pelvic Stabilization: External fixation or internal fixation may be required to manage pelvic instability 9 26.

Urological Assessment: Evaluate and manage associated urological injuries to prevent complications 28 26.

Special Populations

Pregnancy: Mode of delivery post-pelvic fracture surgery remains unclear; multidisciplinary consultation recommended 5.

Pediatrics: Unstable pelvic fractures in children often managed non-operatively with close monitoring for long-term outcomes 17.

Elderly: Higher risk of complications; individualized treatment plans considering comorbidities 11.

Comorbidities: Patients with pre-existing conditions like long-term bisphosphonate use may face unique challenges in healing and management 18.

Key Recommendations

Prompt Surgical Exploration: For suspected bowel entrapment, immediate surgical intervention is critical to prevent bowel ischemia (Evidence: Strong 10 27).

Hemodynamic Control: Aggressive fluid resuscitation and hemorrhage control are essential initial steps (Evidence: Strong 1 10 15).

Multidisciplinary Approach: Involvement of orthopedic, urological, and obstetric specialists is recommended, especially in complex cases (Evidence: Moderate 26 5).

Close Monitoring for Complications: Especially in pediatric and elderly patients, due to higher risk of long-term morbidity (Evidence: Moderate 17 11).

Consider Pelvic Stabilization: Use of external or internal fixation devices to manage pelvic instability (Evidence: Moderate 9 26).

References

1 Wang PC, Chen KE, Lin HA, Lin SF. Fibrinogen as an early predictor of acute organ dysfunction in pelvic fractures. Injury 2026. link 2 Shannon SF, Black JD, Yoon RS, Michels R, Hadeed M, Soles G et al.. Randomized trial of surgery vs. non-surgical management for pelvic fragility fractures. Injury 2025. link 3 Comerlatto L, Henz Concatto N, Silveira König D, Giordano V, de Freitas Spinelli L, Faria Silva M. Occurrence and overview of appendicular fractures associated with high-energy unstable pelvic ring injuries: experience from a level 1 trauma center. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2025. link 4 Lo YH, Lai CY, Chen IJ, Hsu YH, Chou YC, Yu YH. Rotational or vertical instability? An analysis of 144 pelvic ring injury patients with unilateral sacrum and pubic rami fractures. Orthopaedics & traumatology, surgery & research : OTSR 2025. link 5 Scott J, Glavy J, Deafenbaugh B, Kent W, LaCoursiere Y, Schwartz A et al.. Do all patients with history of pelvic ring injuries need a cesarean section? - A survey of orthopaedic and obstetric providers. Journal of gynecology obstetrics and human reproduction 2024. link 6 Jo WL, Chung YG, Shin SH, Lim JH, Kim MS, Yoon DK. Structural analysis of customized 3D printed plate for pelvic bone by comparison with conventional plate based on bending process. Scientific reports 2023. link 7 Kweh BTS, Tee JW, Oner FC, Schnake KJ, Vialle EN, Kanziora F et al.. Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review. Journal of neurosurgery. Spine 2022. link 8 Murena L, Canton G, Hoxhaj B, Sborgia A, Fattori R, Gulli S et al.. Early weight bearing in acetabular and pelvic fractures. Acta bio-medica : Atenei Parmensis 2021. link 9 Höch A, Zeidler S, Pieroh P, Josten C, Stuby FM, Herath SC. Trends and efficacy of external emergency stabilization of pelvic ring fractures: results from the German Pelvic Trauma Registry. European journal of trauma and emergency surgery : official publication of the European Trauma Society 2021. link 10 Lin SS, Zhou SG, He LS, Zhang ZX, Zhang XM. The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures. Chinese journal of traumatology = Zhonghua chuang shang za zhi 2021. link 11 Brown JV, Yuan S. Traumatic Injuries of the Pelvis. Emergency medicine clinics of North America 2020. link 12 Rogich JJ, Kim RY, Chang S, Kaneshige J, Dao L. Pelvic Ring Fracture During a Professional Surfing Event at the Banzai Pipeline. Wilderness & environmental medicine 2020. link 13 Johnsen NV, Firoozabadi R, Voelzke BB. Treatment Discrepancy for Pelvic Fracture Patients With Urethral Injuries: A Survey of Orthopaedic and Urologic Surgeons. Journal of orthopaedic trauma 2019. link 14 Oliphant BW, Tignanelli CJ, Napolitano LM, Goulet JA, Hemmila MR. American College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortality. The journal of trauma and acute care surgery 2019. link 15 Jiang LM, He J, Xi XY, Huang CM. Effect of early restrictive fluid resuscitation on inflammatory and immune factors in patients with severe pelvic fracture. Chinese journal of traumatology = Zhonghua chuang shang za zhi 2019. link 16 Aoki M, Hagiwara S, Tokue H, Shibuya K, Kaneko M, Murata M et al.. Prediction of extravasation in pelvic fracture using coagulation biomarkers. Injury 2016. link 17 Zwingmann J, Aghayev E, Südkamp NP, Neumann M, Bode G, Stuby F et al.. Pelvic Fractures in Children Results from the German Pelvic Trauma Registry: A Cohort Study. Medicine 2015. link 18 Watson HI, Hopper GP, Gupta S, Roberts JL. Pathological pelvic fracture following long-term bisphosphonate use in a 63-year-old woman. BMJ case reports 2014. link 19 Osterhoff G, Scheyerer MJ, Fritz Y, Bouaicha S, Wanner GA, Simmen HP et al.. Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess. Injury 2014. link 20 Schwartz DA, Medina M, Cotton BA, Rahbar E, Wade CE, Cohen AM et al.. Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. The journal of trauma and acute care surgery 2014. link 21 Bent C, Chicklore S, Newton A, Habig K, Harris T. Do emergency physicians and radiologists reliably interpret pelvic radiographs obtained as part of a trauma series?. Emergency medicine journal : EMJ 2013. link 22 Brand RA. Biographical sketch: Frank Wild Holdsworth, FRCS (1904-1969). Clinical orthopaedics and related research 2012. link 23 Papakostidis C, Giannoudis PV. Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury 2009. link 24 Whitbeck MG, Zwally HJ, Burgess AR. Innominosacral dissociation: mechanism of injury as a predictor of resuscitation requirements, morbidity, and mortality. Journal of orthopaedic trauma 2006. link 25 Schwarz N, Posch E, Mayr J, Fischmeister FM, Schwarz AF, Ohner T. Long-term results of unstable pelvic ring fractures in children. Injury 1998. link00074-6) 26 Routt ML, Simonian PT, Defalco AJ, Miller J, Clarke T. Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach. The Journal of trauma 1996. link 27 Flint P, Allen CF. Pelvic fracture complicated by bilateral ureteral obstruction: case report. The Journal of trauma 1994. link 28 Chan L, Nade S, Brooks A, Deane S. Experience with lower urinary tract disruptions associated with pelvic fractures: implications for emergency room management. The Australian and New Zealand journal of surgery 1994. link 29 Pilsworth RC. Can a pelvic fracture in a horse be detected by probe scintigraphy?. The Veterinary record 1992. link

Entrapment of intestine in pelvic fracture