Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review

Abstract

Traumatic incarceration of the small bowel accompanied by vertebral fractures and dislocation is rare and usually misdiagnosed until laparotomy. This report presents a rare case of jejunum entrapment between lumbar spine fractures. A 43-year-old man was clamped between two railway tracks on the upper abdomen and lower back. Following ineffective conservative treatment, he underwent a laparotomy due to the development of guarding and rebound tenderness. Loss of vitality of the jejunal loop, which was incarcerated between the L3 and L4 vertebrae, was observed. The necrotic bowel was removed and end-to-end anastomosis was performed. When his condition was stable, anterior and posterior lumbar fixation surgery was performed. The patient had no abdominal complications and lower limb nerve function deficiency during the follow-up period. A review of the literature since 1979 on incarceration of the bowel associated with lumbar fracture and dislocation identified 12 cases: five patients showed persistent neurological symptoms, but none of the patients died as a result of their injuries. It should be borne in mind that patients with hyperextension or flexion-distraction injury of the lumbar spine could show symptoms of intestinal obstruction and bowel incarceration. Enhanced computed tomography or magnetic resonance imaging will be helpful for diagnosis.

Intestinal obstruction caused by small bowel entrapment within a lumbar fracture: A case report

“…[ 5 ] As in our case, traumatic vertebral fractures or dislocation-induced intestinal entrapment are extremely rare, and a study published in 2019 indicated that only 12 cases were reported from 1979 to 2016. [ 4 ] It is not a direct injury to the intestine due to instantaneous force from trauma, but rather a severe hyperextension injury of the spine, which is induced by torn anterior longitudinal ligament and herniation of the intestine. [ 6 , 7 ] This is due to obstruction and bowel strangulation caused by hernias may appear as symptoms.…”

“…[ 3 , 4 , 7 , 11 ] If bowel entrapment due to a fracture or dislocation of the spine is suspected, surgical treatment is necessary to manage the risk of complications or subsequent infection due to intestinal perforation. [ 4 ]…”

“…In patients with vertebral fractures due to trauma, bowel obstruction is commonly caused by paralytic ileus related to retroperitoneal hematoma. [ 4 ] Paralytic ileus is caused by immobility due to spinal injury or the postoperative state, and opioid analgesics used for pain control also reduce gastrointestinal motility. [ 12 , 13 ] As paralytic ileus and mechanical obstruction can be distinguished with a simple physical examination, they can be easily differentiated if the medical staff is suspected.…”

“…[3,4,7,11] If bowel entrapment due to a fracture or dislocation of the spine is suspected, surgical treatment is necessary to manage the risk of complications or subsequent infection due to intestinal perforation. [4] Therefore, if symptoms of obstruction appear in the early stages of spinal trauma, careful differentiation from other causes is necessary. In patients with vertebral fractures due to trauma, bowel obstruction is commonly caused by paralytic ileus related to retroperitoneal hematoma.…”

“…[ 1 ] Occasionally, mechanical bowel obstruction due to blunt trauma occurs [ 2 ] ; however, mechanical obstructive bowel injury caused by a vertebral fracture or dislocation site is extremely rare. [ 3 , 4 ] We report a rare case of obstructive small bowel injury caused by entrapment of the small intestine between a fracture site of the 5 th lumbar vertebra due to trauma.…”