Bladder Entrapment after External Fixation of Traumatic Pubic Diastasis: Importance of Follow-Up Computed Tomography in Establishing Prompt Diagnosis

Abstract

A 30-year-old male was an unrestrained driver in a high-speed motor vehicle crash. On presentation, the patient was profoundly hypotensive with multiple injuries, including a 20-cm-deep perineal laceration with avulsion of the rectum, a diffusely tender abdomen, an unstable open-book pelvic fracture, and multiple rib fractures. Blood noted at the urethral meatus prompted a retrograde urethrogram and cystogram, which were within normal limits. A Foley catheter was placed with the return of clear urine. Closed reduction and external fixation of the pelvic fracture were performed emergently without difficulty. Postoperative computed tomography of the abdomen and pelvis revealed a retrovesical pelvic hematoma and entrapment of the bladder in the reduced pubic symphysis diastasis. Lower abdominal exploration revealed an intact bladder without evidence of gross bladder wall injury. On release of the external fixator, the bladder was easily reduced into the normal retropubic location. Definitive internal fixation of the pubic diastasis was performed. No urologic sequelae were noted postoperatively.

Bladder incarceration following anterior external fixation of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation

“…Immediate postoperative CT scanning of the pelvis showed persistent herniation, which was addressed through formal open treatment. We agree with previous recommendations that when difficulty in obtaining a closed reduction is experienced, incarcerated soft tissue should be considered [ 10 , 11 , 20 ].…”

“…A review of the literature returned nine previous reports of bladder herniation through a traumatic symphyseal diastasis, only two of which involved actual bladder incarceration after anterior external fixation [ 10 , 11 , 17 - 23 ]. The first report by Fuhs and associates [ 17 ] describes a patient treated in a pelvic sling with initial adequate reduction of the symphyseal diastasis.…”

“…The use of anterior pelvic external fixation has been shown to be a reliable and effective means to stabilize pelvic injuries in the acute resuscitative phase of the trauma patient [ 6 - 9 ]. However, urologic injuries, particularly bladder entrapment, remain a concern with the use of closed reduction of symphyseal disruption and anterior pelvic external fixation [ 10 , 11 ]. We report a case involving bladder herniation through a traumatic symphyseal diastasis with subsequent incarceration after attempted reduction with pelvic external fixation and a review of the literature.…”

Bladder incarceration following anterior pelvic infix of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation

“…16 An intraoperative inlet view cystogram during attempted reduction and external fixator application has been recommended by Cass et al 17 Only three reports of incarceration of the bladder after anterior external fixation and reduction of a pubic diastasis. [18][19][20] The entrapped bladder can easily be delineated with a postoperative CT cystogram. Bartlett et al had attempted remanipulation of the pelvis and fixator but failed to reduce the incarcerated bladder.…”

Recurrent episodes of micturition with expulsion of symphyseal plate screws following pelvic ring fixation: case report

“…Bladder rupture after open reduction with internal fixation of the pelvic ring has been described previously as a late event in two cases [ 3 , 4 ]. Acute bladder entrapment by external fixation has also been described [ 5 ].…”