Objective: Bladder injuries can be fatal if mismanaged. We report a small series of eight patients with a pelvic fracture causing bladder injury, where the bony spicules were intruding the bladder musculature, preventing it from healing, thereby leading to fistula, sepsis and death.
Methods: 8 patients had a pelvic fracture along with a bladder injury. All the patients were initially operated on by a general surgeon, either immediately (4 patients) or after delayed diagnosis of a bladder rupture was made. In all cases, the bladder was primarily closed with both a suprapubic and periurethral catheter. Post-operatively, all the patients developed urine leakage and wound infection. Patients were later referred to us in a state of septicemia. After initial resuscitation and hemodynamic stabilization, all patients were subjected to re-exploration. The bladder was sutured with an omental graft and urinary diversion in the form of bilateral ureteric catheters, a suprapubic catheter, and periurethral catheter was done. All the patients developed recurrent urinary leakage after a variable period of time and landed in septicemia. Bilateral nephrostomies were done; however, these patients continued to deteriorate and succumbed.
Conclusions: Early detection and early repair is the key to success in a bladder injury. Bilateral percutaneous nephrostomy and re-exploration with bladder drainage does not help once sepsis sets in.
Bladder Trauma, pelvic fracture, percutaneous nephrostomy.