Evaluating the incidence of ileus in patients with pelvic ring and acetabular fractures in Major Trauma: a retrospective cohort audit at a Major Trauma Centre (July 2024-June 2025).

INTRODUCTION

Pelvic ring and acetabular fractures usually result from high-energy trauma. Management may be conservative or surgical and is determined by fracture pattern, its associated stability and patient characteristics. Ileus refers to temporary inhibition of gastrointestinal motility without mechanical obstruction. The purpose of this audit is to determine the incidence of ileus in polytrauma patients with pelvic ring and/or acetabular fractures. We also assessed gastrointestinal recovery using the GI-2 endpoint, defined as tolerance of oral diet and passage of stool.

METHODS

A retrospective cohort audit of 98 consecutive patients admitted to the Major Trauma Unit in a Major Trauma Centre (July 2024–June 2025) was conducted using electronic care records. Data collected included patient demographics; mechanism of injury; fracture classification; management; and clinical outcomes; length of stay, days from admission to tolerating oral diet or nasogastric feeding, and days to first bowel opening. Analysis sought to compare gastrointestinal function in relation to the collected variables.

RESULTS

The incidence of clinically significant ileus in patients with pelvic ring and/or acetabular fractures was 4.12% (4/97). 80.4% (78/97) of patients failed to achieve GI-2 by day 3 inclusive. Apart from patients who developed ileus, failure to achieve GI-2 by day 3 inclusive was attributable to delayed passage of stool despite adequate dietary tolerance, reflecting constipation. Age, fracture type, management strategy and presence of concurrent abdominal injury were not associated with bowel outcome. In surgically managed patients, median time to operation was 3.5 (IQR 2.0 to 5.0, range 1–17) days. There was a positive correlation between length of stay and time to bowel opening: Pearson correlation = 0.498 (95% CI 0.324 to 0.636), p < 0.001.

CONCLUSION

The incidence of ileus in patients with pelvic and/or acetabular fractures was lower than previously reported (4.12% vs. 40.4%). This discrepancy is most likely driven by differing diagnostic criteria, with early surgical management and mobilisation also potentially contributing. Most patients in this cohort experienced constipation, which was associated with a 6.5 day longer hospital stay, enforcing the importance of bowel assessment and care in the management of polytraumatised patients.