Small-bowel incarceration and perforation through a hernia defect associated with a pubic fracture: a case report.

Background: We encountered an extremely rare case of delayed small-bowel incarceration and perforation resulting from herniation through a defect at the site of a pubic fracture. Presentation of case: A 69-year-old man receiving conservative treatment for a pubic fracture presented with abdominal pain approximately 3 months after the initial injury. Contrast-enhanced computed tomography revealed free intraperitoneal air, ascites, and small-bowel dilatation, prompting emergency surgery. Intraoperative findings demonstrated ileal incarceration within a depression at the pubic fracture site, consistent with a Richter-type hernia accompanied by small-bowel perforation. Partial ileal resection with functional end-to-end anastomosis was performed, and the hernial defect was packed with omental tissue. Osteomyelitis observed at the fracture site was treated with antibiotics. The patient was discharged on postoperative day 40. Discussion: Although rare, small-bowel herniation through a pelvic fracture site can result in incarceration and perforation. In this case, hernia repair was challenging because of contamination at the hernia site, which made mesh placement difficult, and the presence of a rigid hernia defect formed by an acquired bony defect, which was difficult to close with sutures. Based on a review of 11 cases reported between 2008 and 2026, including the present case, no standardized repair method has been established to date. Conclusion: Treatment strategies should be individualized and include omental filling, fracture stabilization, and closure or management of the hernia.