Polytrauma with pelvic fracture associated traumatic hernia and multiple hollow viscera injuries: a rare case report.

Introduction and importance: Road traffic accidents (RTAs) are the leading cause of polytrauma worldwide. Traumatic hernias from pelvic fracture defects and multiple hollow viscus injuries are very rare in blunt abdominal trauma and may involve high-energy mechanisms. Their coexistence with complex pelvic ring fractures and thoracic injuries poses significant diagnostic and management challenges, particularly in physiologically unstable patients. Case presentation: This is a case report of a 66-year-old male who presented to the emergency department following a high-velocity RTA with hemorrhagic shock and multiple musculoskeletal injuries. After initial resuscitation, further examination and imaging revealed a traumatic hernia through a right iliac fracture defect, with associated bilateral pelvic fractures and a hollow viscus injury. Management was complicated by the patient's severe physiological derangement and delayed operative consent from surrogate decision-makers. A definitive repair, rather than damage-control strategies, was performed. However, he later suffered a cardiopulmonary arrest and could not be resuscitated. Discussion: This case documents a previously unreported combination of injuries in a hemodynamically unstable patient. Clinical decisions for management must be guided by the patient's physiological status, as the intervention itself may influence the patient's outcome. While damage control surgery is the standard of care, it was precluded by the family's refusal due to financial constraints, reflecting real-world realities in low-resource settings. Conclusion: Severe blunt polytrauma with a pelvic fracture-associated traumatic hernia and concurrent hollow viscus injuries, including sigmoid transection with devascularization, represents a surgical emergency. This case adds to the limited literature on herniation via traumatic pelvic fractures.