Korean J Urol.  2012 Dec;53(12):887-889. 10.4111/kju.2012.53.12.887.

Delayed Presentation of Intravesical Bone Penetration after Pelvic Ring Fracture

• Kim JH
• Ha YC
• Kim TH
• Myung SC
• Moon YT
• Kim KD
• Chang IH

• KMID: 1988738
• DOI: http://doi.org/10.4111/kju.2012.53.12.887

Abstract

Retrograde cystography and computed tomography (CT) are considered the gold standard for investigating bladder and pelvic bone injury. However, these methods can miss extraperitoneal bladder rupture caused by a penetrating bone fragment from a pelvic bone fracture. We experienced a routine conventional cystography and CT scan that failed to identify penetration of the bladder by a bone fragment, which thus delayed optimal treatment. Therefore, different diagnostic methods such as CT cystography or cystoscopy should be considered to rule out penetrating injury by a bony fragment in patients with extraperitoneal bladder rupture.

Keyword

Delayed diagnosis; Injuries; Pelvic bones; Urinary bladder

MeSH Terms

Cystoscopy
Delayed Diagnosis
Humans
Pelvic Bones
Rupture
Urinary Bladder

Figure

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  FIG. 1 Pelvic bone 3D reconstruction computed tomography showed a comminuted fracture in both sacral ala involving both the sacral foramen and the left sacroiliac joint, multifocal fractures in both superior pubic rami and both inferior pubic rami, and a comminuted fracture in the left acetabulum, anterior wall.

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  FIG. 2 Cystography showed an extraperitoneal bladder rupture near the bladder neck when we filled the bladder with 150 ml of contrast material.

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  FIG. 3 Cystoscopy showed perforation of the anterior bladder wall by a bony fragment.

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  FIG. 4 At the surgical exploration by a suprapubic approach, we found a small bony fragment penetrating the bladder wall. We removed the bony fragment and repaired the bladder at that field.

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