Iliac crest bone graft donor site hernia: not so uncommon

Abstract

SUMMARYA 73-year-old man, who had undergone fracture fixation of humerus with LCP plating and bone grafting, presented again with a peri-implant fracture after 1 year. A repeat surgery was contemplated and replating was performed with tricortical bone graft harvested from the iliac crest. In the postoperative period the patient developed a tender swelling at the graft site with nausea and abdominal discomfort. It was managed conservatively thinking it to be a haematoma at the graft site. In the following 2 days his symptoms worsened. A CT abdomen showed the herniation of caecum from the bone graft donor site with obstruction. The patient was taken up for emergency surgical repair, the caecum was reduced and polypropylene mesh hernioplasty was performed. The patient recovered well without recurrence in the follow-up period. Iliac crest bone graft site hernia is not so uncommon and care has to be taken while harvesting. BACKGROUND

A Rare Case of Large Bowel Obstruction Secondary to Bone Grafting

“…Although rare, gastrointestinal herniation through the iliac bone defect is not unknown [2,3]. These cases usually present with incarceration (25%) or strangulation (10%) [4].…”

“…About 40 cases have been reported so far. The incidence reportedly varies between 5% and 9%, and is common among females, older individuals (>65 years), malnourished, obese patients, and in cases where full thickness graft is harvested from the middle portion of iliac crest [3].…”

“…Care should be taken to avoid injuring the peritoneum while performing graft harvest. Other technologies like bone substitutes and cell therapy may also be considered [3].…”

A Case of Iliac Crest Avulsion with Peritoneal Disruption and Bowel Herniation after Blunt Trauma

“…Bowel herniation through iliac crest after iliac crest bone harvests has been described in orthopedic literature. [7][8][9] The iliac crest is commonly used as harvest site for bone grafts in orthopedic procedures. The incidence rate of bowel herniation after iliac crest harvest has been estimated to be 5 to 9 per cent, and approximately 40 cases have been described in the literature.…”

“…There is no consensus for the ideal method or timing of surgical repair. 5,7,8 We describe a case of large bowel herniation with associated iliac crest avulsion fracture and concomitant intraperitoneal bladder rupture after blunt trauma.…”