Small bowel perforation caused by compound pelvic fracture found in diagnostic laparoscopy

Small bowel perforations in blunt abdominal trauma (BAT), especially in multiply injured patients, are difficult to diagnose in the first hours after the accident, either clinically or by imagistic studies. A less encountered diagnostic modality is diagnostic laparoscopy (DL), selectively indicated. We present the case of a patient with BAT and complex pelvic fracture, hemodynamically stable, with TS= 15, who clinically had abdominal tenderness and on ultrasound (US) and CT scan, had free intra-abdominal fluid (FIAF), without any injuries of a solid viscus, which led us to suspect a hollow viscus injury. We proceeded with a DL, imposed by the equivocal diagnosis, taking advantage of the general anesthesia needed for the femoral and pelvic fracture immobilization. We identified an ileal perforation and decided to convert to open surgery, and we found a second perforation. Segmentary ileal resection was performed. Orthopedically, in emergency, the femoral fracture and the posterior arch of the pelvis were immobilized, but due to the septic risk, the anterior arch was immobilized 10 days later. DL is a valuable tool in BAT with FIAF on US and CT scan with suspicion of hollow viscus perforation in the hemodynamically stable patients, in order to decide between laparotomy and observation. In equivocal diagnosis cases, DL avoids unnecessary or delayed laparotomy. Whenever possible and indicated, orthopedic lesions will be dealt with in emergency ("early total care"), in order to reduce the recovery and hospitalization period.