Background Major pelvic fractures are often associated with intra-abdominal organ injuries. Considering patients’ hemodynamic status, Focused Assessment with Sonography for Trauma (FAST) can facilitate decision-making for abdominal exploration. Non-therapeutic exploratory laparotomy from pelvic fractures should be avoided. Aim of this study is to determine the accuracy of FAST in diagnosing significant intraabdominal hemorrhage that leads to determine whether or not to pursue therapeutic abdominal exploration in patients with major pelvic fractures. Material and methods We systematically reviewed the PubMed and SCOPUS databases from 2009 to 2019 and also using a retrospective review of patients admitted to the Acute Care Surgery service from 2016 to 2019. We performed a meta-analysis by using a random effects model. Results A total 677 patients were analyzed, 28 cases from our hospital. Mean patient age was 40.8 years. Leading mechanism of injury were motor vehicle collision (44.72%), fall from height (13.41%), and motorcycle collision (13.69%). Average injury severity score (ISS) was 32.5 (range: 24.1–50), and overall mortality rate was 11.65%. The pooled sensitivity, specificity, and accuracy of FAST to identify significant intra-abdominal hemorrhage was 79%,90%, and 93%, respectively (95% confidence interval: 89%–94%). Meta-regression revealed no significant correlation between injury severity score and the accuracy of FAST. Conclusion Our meta-analysis revealed that FAST in major pelvic fracture accurately detected significant intra-abdominal hemorrhage. Using FAST in the presence of unstable hemodynamics, we can decide to perform abdominal exploration with the expectation of finding significant intra-abdominal hemorrhage require surgically control.

Background. Blunt force injuries in patients with preexisting kidney disease account for 19% of all kidney injuries, suggesting that diseased kidneys are more vulnerable than normal kidneys. When a horseshoe kidney (a rare anomaly: prevalence of 0.2%) is injured, treatment is challenging, especially when nonoperative management is desired. In high-grade blunt force normal kidney injury, nonoperative management has high succession rate (94.8%) with kidney-related complication (13.6%). Surgical reconstruction and preservation of a damaged horseshoe kidney is difficult because of variations in its vascular anatomy. We report successful nonoperative management of a blunt horseshoe kidney injury with active bleeding and review previous outcomes and complications. Case Presentation. A 57-year-old man had a head-on collision motorcycle road traffic accident. On arrival, blood pressure was 90/60 mmHg, pulse rate 140 bpm, and clear yellow urine output 200 ml. The patient was transiently responsive to fluid and blood component. Whole body computed tomography showed a high-volume retroperitoneal hematoma and multiple-lacerated lower pole of the kidney, compatible with preexisting horseshoe kidney disease with active contrast-enhanced extravasation from the accessory right renal artery. Embolization was performed. Renal function, transiently impaired after embolization, normalized on day 3. An infected hematoma found on day 7 was successfully controlled with antibiotics. His recovery was uneventful. At the 6-month follow-up, his serum creatinine level had returned to normal. The average age of blunt force horseshoe kidney injury is 31.75 years and occurred more common in male (87.5%). Conclusion. Diseased horseshoe kidneys are prone to injury even with low-velocity impact such as a road traffic accident speed<15 km/h. Embolization is considered the first choice for management, with its high clinical success rate leading to less need for surgical repair. Not removing a hematoma is likely to result in complications. If embolization fails to stop bleeding, life-saving surgical exploration should be mandated.