Hemodynamically Unstable Pelvic Injury Case submitted by Chip Routt, MD - Harborview, Seattle
Case 1
The patient is a 33 yo male injured in an auto accident. He had a positive
DPL, hematuria, and unstable pelvis to exam. Bladder and urethral injuries
accompanied right SI joint and symphyseal disruptions. An urgent laparotomy was
performed which was not possible to close. Abdominal contents were contained by a
marlex sheet. An external frame was applied to the anterior pelvis prior to an
angiographic embolization of the iliac system on the right.
At 18 hours post injury, with the patient hypotensive, tachycardic, a Hct of
23 and with urine extravasating from the abdominal wound, he was returned to the
operating room for symphyseal open reduction and plating. The fluoro images
demonstrate the residual SI joint displacement after symphyseal plating and the
iliosacral screw sequence. The bladder and urethral injuries were repaired at the
same anesthetic immediately after iliosacral screw insertion.
