Delayed Presentation of Intravesical Bone Penetration after Pelvic Ring Fracture
A 33-year-old female patient who was in a traffic accident was transferred to the emergency room. Plain pelvic radiography showed a complex pelvic ring fracture. After a urethral Foley catheter was inserted, gross hematuria was evacuated. The abdomen-pelvis CT scan showed 2.7-cm and 1.1-cm lacerations in the right lobe of the liver, direct contusion to the pancreas and retroperitoneal portion of the duodenum, a comminuted fracture in both the sacral ala and ischium, and a moderate amount of fluid collection in the perivesical space, which suggested extraperitoneal bladder rupture (). We confirmed the extraperitoneal bladder rupture near the bladder neck by use of cystography (). Because of her multiple organ injuries, the patient underwent conservative treatment of the fractures with placement of an indwelling bladder catheter until healing of the extraperitoneal bladder injury. Two weeks later, repeated cystography was performed, which showed no leakage of the contrast materials. However, the urethral Foley catheter was kept in place because the patient required absolute bed rest owing to her pelvic bone fracture. After 30 days of hospitalization, the patient complained of lower abdominal discomfort; pyuria was shown on urine analysis and the patient had a febrile episode. The repeated abdominal CT scan showed complete absorption of urine in the perivesical space except on a small bladder stone. We performed cystoscopy to remove the bladder stone and at that time discovered the perforation of the anterior bladder wall by the bone fragment (). We excised the perforating bone fragment and repaired the perforated bladder wall by a suprapubic surgical approach (). The pelvic bone fracture and the bladder rupture were completely healed without any complication at the 6-month follow-up.