Complex bladder and small bowel injury induced by gamma nail fixation: a case report

Trochanteric fractures in elderly patients are frequently treated with gamma intramedullary nails. Although commonly performed, this procedure can result in rare but severe complications such as visceral perforation. The case involves an elderly woman who suffered iatrogenic perforation of both the urinary bladder and small intestine during gamma nail insertion. The complication was not immediately recognized, and the patient presented several weeks later with severe sepsis and pelvic peritonitis. Imaging and cystoscopy confirmed the diagnosis. Emergency surgery allowed for small bowel resection and bladder repair, with the nail left in place. The postoperative course was complicated by a vesicocutaneous fistula requiring urinary diversion. This case exemplifies the consequences of insufficient intraoperative imaging during gamma nail fixation in elderly patients. Prompt recognition and multidisciplinary management are essential to reduce morbidity and improve outcomes in such rare but life-threatening scenarios.