Intra-Abdominal Migration of a Guide Pin Revealed by Early Postoperative Small Bowel Obstruction Following Hip Fracture Fixation : A Case Report

Migration of orthopedic fixation devices is a recognized complication of fracture surgery. However, intra-abdominal migration of a guide pin during hip fracture fixation remains an exceptionally rare and potentially life-threatening event because of the proximity of major vascular and visceral structures. We report the case of a 71-year-old woman who underwent surgical fixation of a right femoral neck fracture. Migration of a guide pin, likely initiated intraoperatively, remained unrecognized until postoperative day 2, when the patient developed acute small bowel obstruction characterized by abdominal pain, abdominal distension, and cessation of bowel movements and flatus. Plain abdominal radiographs revealed dilated bowel loops associated with an abnormal position of the guide pin. Computed tomography confirmed intra-abdominal migration of the guide pin, demonstrating an oblique trajectory across the abdominopelvic cavity in close proximity to the iliac vessels, urinary bladder, and small bowel loops. Emergency laparotomy confirmed the diagnosis, allowed safe extraction of the guide pin, and relieved the intestinal obstruction without associated visceral injury. The postoperative course was uneventful. This case highlights the importance of early diagnosis, appropriate imaging assessment, and prompt surgical management of this rare but potentially severe complication.