[Traumatic jejunal entrapment in a patient with Bechterew disease]

What is the onset mechanism of internal hernia after vertebral body fracture? A case of internal hernia secondary to traumatic vertebral fracture

A 67-year-old man who had been pinned between a basket crane and a tree complained of severe pain in his lower back and a decreased appetite. Laparotomy after decompressing the gastrointestinal tract revealed incarceration of an ileal loop within a fractured third lumbar vertebra. The damaged bowel was resected, and an end-to-end anastomosis was performed. Once the patient's condition had stabilised, posterior lumbar fixation was performed. There were no abdominal complications or lower limb neurological deficits during the follow-up period. Enhanced CT and MRI had been helpful in making the diagnoses. Histopathological examination revealed the aetiology of the traumatic incarceration: the intestine had been pinched as the disc space closed, and the body attempted to return to its original state by exerting countertraction.

Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review

Traumatic incarceration of the small bowel accompanied by vertebral fractures and dislocation is rare and usually misdiagnosed until laparotomy. This report presents a rare case of jejunum entrapment between lumbar spine fractures. A 43-year-old man was clamped between two railway tracks on the upper abdomen and lower back. Following ineffective conservative treatment, he underwent a laparotomy due to the development of guarding and rebound tenderness. Loss of vitality of the jejunal loop, which was incarcerated between the L3 and L4 vertebrae, was observed. The necrotic bowel was removed and end-to-end anastomosis was performed. When his condition was stable, anterior and posterior lumbar fixation surgery was performed. The patient had no abdominal complications and lower limb nerve function deficiency during the follow-up period. A review of the literature since 1979 on incarceration of the bowel associated with lumbar fracture and dislocation identified 12 cases: five patients showed persistent neurological symptoms, but none of the patients died as a result of their injuries. It should be borne in mind that patients with hyperextension or flexion-distraction injury of the lumbar spine could show symptoms of intestinal obstruction and bowel incarceration. Enhanced computed tomography or magnetic resonance imaging will be helpful for diagnosis.

Invagination of intra-abdominal structures in the lumbar intervertebral disc space

Invagination of peritoneal or retroperitoneal structures into the intervertebral disc space of the lumbar spine is extremely rare. In this article the imaging features and clinical findings are demonstrated in four patients with intervertebral invagination of intra-abdominal structures. Plain radiographs, CT scans, and MR images showed disruption of the anterior ligamentous complex (ALC) and invagination of various structures into the disc space, including the vena cava, iliac vessels, intestine, the torn redundant anterior longitudinal ligament, retroperitoneal fat, and the psoas muscle. The invaginations occurred at the level of L3-L4 and L4-L5 in one case each and at L5-S1 in two cases. Follow-up imaging in three cases (1, 5, and 8 years respectively) showed the progression of the invagination. These cases demonstrate that a close evaluation of this condition is necessary, particularly for older patients who show disruption or laxity of the ALC, degenerative spondylosis with chronic segmental instability, and osteoporosis of the lower lumbar spine.