Staged operative treatment in a septic patient with an infected, unstable pelvis, and a missed bladder rupture.
This case demonstrates once again the potential and serious complications of pelvic fractures, especially when associated urogenital injuries are missed. Missing the bladder rupture proved almost fatal to our patient. Second, it was confirmed that in very unstable pelvic fractures, external fixation alone does not provide enough stability. Local stability is the cornerstone in the treatment of (bone) infection, and in these cases, maximal stability is only obtainable with internal fixation. The advantages of metal implants in infected areas outweigh the disadvantages by far. For the bladder-rupture, we chose a two-stage approach. First, we performed a urinary diversion, to avoid surgical closure of the infiltrated bladder wall. All cavities, including the open bladder, were packed with omentum to fill the dead space with highly vital tissue to offer stout resistance to infection. Two years later, with the patient in excellent physical condition, urinary undiversion was carried out. Ultimately physical and social recovery was complete.
Hulscher
J B
JB
Department of Surgery, Academic Hospital Utrecht, The Netherlands.
Boon
T A
TA
van der Werken
C
C
D000038:Abscess / Q000150:complications; D000063:Accidents, Traffic; D001860:Bone Plates; D004927:Escherichia coli Infections / Q000150:complications; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D012421:Rupture; D018805:Sepsis / Q000150:complications*; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D014547:Urinary Diversion