Bowel Rupture in Patients with Pelvic Fractures: A Systematic Review of Diagnostic Challenges, Surgical Management, and Multidisciplinary Trauma Care

Abstract

Background: Bowel rupture associated with pelvic fractures is a rare but life-threatening complication of high-energy trauma. Its diagnosis is often delayed due to nonspecific clinical presentation and competing injuries, resulting in increased morbidity and mortality. Objective: To systematically review the current evidence on epidemiology, diagnostic approaches, surgical management, and outcomes of bowel injury in patients with pelvic fractures. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and Google Scholar were searched for studies published between 2004 and 2026. Eligible studies included adult patients with pelvic fractures and associated bowel injury, reporting diagnostic methods, surgical interventions, or outcomes. Study selection was performed independently by two reviewers. Methodological quality was assessed using the Newcastle-Ottawa Scale and AMSTAR-2 criteria. Due to heterogeneity, findings were synthesized narratively. Results: Thirty studies were included in the qualitative synthesis. Bowel injury was most commonly associated with high-energy blunt trauma, particularly road traffic accidents. Contrast-enhanced CT was identified as the primary diagnostic modality, although early injuries may be missed. Early exploratory laparotomy significantly reduced morbidity and mortality, while delayed diagnosis was associated with increased rates of sepsis and peritonitis. Damage control surgery was beneficial in hemodynamically unstable patients. Multidisciplinary trauma care and early pelvic stabilization improved overall outcomes. Reported mortality rates ranged from 20% to 50%, particularly in cases with delayed intervention. Conclusion: Early recognition, prompt surgical intervention, and coordinated multidisciplinary management are essential in improving outcomes in patients with bowel rupture associated with pelvic fractures. Advances in imaging and trauma protocols have improved survival; however, further research is needed to enhance early diagnostic accuracy and standardize management strategies.