Pelvic trauma with embolisation

Case contributed by RMH Core Conditions

Presentation

Pedestrian vs car.

Patient Data

Age: 45 years
Gender: Male

There is diastasis of the pubic symphysis, with the left pubis superiorly displaced and overriding the right pubis.

There are comminuted fractures through both sacral alae with elevation of the lateral fragment of the left sacrum and a fracture of the left L5 transverse process. The fractures involve the sacral foramina bilaterally, and there is also extension into both sacroiliac joints. No associated SI joint dislocation.

There is an associated moderate sized extraperitoneal pelvic haematoma within the left hemi-pelvis with extension of haematoma into the posterior pararenal space of the left retroperitoneum. There is also intramuscular and subcutaneous haematoma within the left groin, and haematoma within the left lower abdominal wall.

Wedge shaped areas of low density within the left kidney are favoured to represent renal infarcts, with the differential including renal laceration. The renal hilar vessels appear preserved.

No liver, pancreatic, adrenal or splenic injuries.No lumbar spine fractures.

Conclusion

  1. Unstable pelvic fractures, suggestive of vertical shear mechanism of injury. Associated extraperitoneal pelvic haematoma.
  2. Wedge shaped low density defects within the left kidney - either represent renal infarcts or lacerations.
DSA (angiography)

Left lateral sacral artery transection with significant active bleeding. This was successfully coil embolised using: 6 x Straight 5mm Pushable -18; 2 x Hilal Straight 1cm. Possible patchy small foci of internal iliac branches extravasation: Successfully treated with gelfoam slurry until complete stagnancy.

Two renal arteries on the left. Left inferior renal artery proximal dissection just beyond origin: Treated with a 3 x 24mm stent

Case Discussion

Pelvic haemorrhage without associated intraperitoneal haemorrhage can be treated with angioemoblisation with bleeding controlled in ~90% (85-97%) of cases.

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Case information

rID: 28572
Case created: 31st Mar 2014
Last edited: 11th Jul 2017
Inclusion in quiz mode: Included

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