Colon perforation from an uncommon cause: a case report

Pelvic fractures are frequently associated with concomitant injuries to intra-abdominal and genitourinary structures. We report an unusual case of colonic perforation secondary to entrapment of the sigmoid colon within a complex pelvic fracture. A 59-year-old male sustained a high-energy blunt trauma following a motor vehicle rollover. Upon presentation to the Emergency Department, he was responding with an intact airway and hemodynamically normal and stable. Auscultation revealed normal and symmetrical breath sounds bilaterally (SpO2 98%). The patient was alert, oriented, and scored 15/15 on the Glasgow Coma Scale. Physical examination revealed pelvic instability. Whole-body computed tomography (CT) demonstrated an anteroposterior compression (APC) Type III pelvic ring injury with herniation and perforation of the sigmoid colon into the fracture site, accompanied by free air. The patient underwent emergency exploratory laparotomy, which confirmed the diagnosis. A sigmoidectomy with Hartmann’s procedure was performed. Definitive pelvic stabilization was achieved in a subsequent operative session. Incarceration of bowel loops within pelvic fractures is exceedingly rare but represents a surgical emergency due to the risk of fulminant sepsis and mortality. Early radiologic identification and prompt surgical management are imperative. A high index of suspicion is warranted in patients with complex pelvic fractures, particularly in the presence of free intraperitoneal air or signs of peritonitis.