Delayed Small Bowel Incarceration Within a Lumbar Burst Fracture After Posterior Spinal Fusion: A Case Report

We present a case report of a patient who had delayed small bowel obstruction secondary to an incarcerated loop of small bowel within an acute lumbar spine fracture. The patient was involved in a rollover motor vehicle accident, resulting in lumbar spine fractures at L2-4. A comminuted fracture of the L3 vertebral body with likely disruption of the anterior longitudinal ligament (ALL) was noted. The patient underwent L1-4 posterior spinal fusion with the introduction of mild lumbar lordosis to prevent future complications of flatback syndrome. On postoperative Day 4, the patient was noted to have signs and symptoms of progressive small bowel obstruction. Conservative management was initiated with minimal improvement. The patient was taken to the operating room on postoperative Day 7 for an exploratory laparotomy. A necrotic loop of small bowel was noted to be entrapped in the ventral L3 vertebral body defect. This bowel was released and resected, with side-to-side anastomosis performed. No previous cases describe small bowel incarceration because of posterior spinal fusion for trauma. The introduction of increased lumbar lordosis is thought to have contributed to this risk of small bowel herniation, and care must be taken when determining appropriate spinopelvic parameters in these cases.