A rare case of Small Bowel Rupture due to a Richter-like hernia following a pelvic fracture

Background. Pelvic fractures are severe injuries often associated with multiple systematic injuries. The most common related complications are: bleeding, retroperitoneal hematoma, other intra-abdominal and urogenital injuries. There are also rare types of pelvic fracture complications such as ureteral obstruction, bowel entrapment, external iliac artery injury and open scrotal sac injury. Traumatic hernias on pelvic injuries sites are an extremely rare entity.

            Case presentation. A 79-years old woman was admitted to the Accident and Emergency Department suffering from a left pubic rami fracture with active retroperitoneal bleeding from the left obturator artery following a fall from her own height. Bleeding was managed with intravascular embolization. Her initial uneventful clinical course was discontinued by relapsing episodes of bowel obstruction and eventually lethal septic syndrome due to bowel perforation due to a Richer-like-hernia as it turned out. Despite rescue laparotomy during which an enterectomy, lavage and laparostomy were performed the patient passed out in the midst of decaying multiple organ failure syndrome.

            Conclusion. Traumatic hernias associated with pelvic fractures complicated with bowel entrapment, is a rarity. Although there are few reports for bowel entrapment into traumatic cavities of such hernias, the presence of Richter-like traumatic hernia has no record in the literature until today. Every surgeon dealing with trauma should be aware of the existence of such a rare complication and have a low threshold for early surgical intervention.