Small bowel incarceration associated with lumbar fracture: a case report and literature review

This study aimed to summarize the characteristics of lumbar fractures complicated with bowel incarceration by reviewing relevant cases, thereby offering a reference for early clinical diagnosis and treatment. A retrospective analysis was conducted on a patient with a lumbar fracture complicated by small bowel incarceration, who was admitted to the Third Hospital of Hebei Medical University. Meanwhile, a supplementary literature search was performed in the PubMed, CNKI, and Wanfang databases to identify previously reported cases, which were subsequently combined with the case from our hospital. The investigation identified 20 cases of lumbar fractures complicated by bowel incarceration, which were analyzed alongside the solitary case from our hospital. The 21 patients’ ages varied from 3 weeks to 67 years. The major cause of injuries was high-energy trauma (20/21, 95.24%). Fractures occurred at or above the L3 vertebral body in 13 cases, accounting for 61.91% of cases. All patients presented with varing degrees of intestinal obstruction symptoms. Vomiting was the most common symptom (11/21, 52.38%), followed by abdominal distension (9/21, 42.86%) and abdominal pain (9/21, 42.86%). Systemic signs, such as fever and chills, occured in 2 patients (9.52%). Regarding outcomes, 12 patients (57.15%) achieved a favorable recovery without clinical symptoms; 7 patients (33.33%) experienced residual neurological impairment of varied severity; 1 patient (4.76%) remained in a vegetative state, and 1 patient (4.76%) died of septic shock. For patients with lumbar hyperextension injury accompanied by blunt abdominal trauma, persistent intestinal obstruction that does not response to conservative treatment should raise suspicion of small bowel incarceration. Early surgical exploration is therefore recommended.