Bladder necrosis secondary to internal iliac artery embolization following pelvic fracture

Abstract

A 49-year-old man following a road traffic accident (RTA) had an unstable pelvic fracture with urethral injury. Internal pelvic fixation with Supra-pubic catheter (SPC) drainage of his bladder was done. This failed to stop the bleeding and a pelvic angiography with bilateral internal iliac embolization using steel coils was performed successfully controlling the bleeding. After 4 weeks, the patient developed wound infection (Clavien Grade III) and on exploration, bladder necrosis was found. A urinary diversion using ileal conduit with excision of bladder was performed. A biopsy of the excised bladder confirmed bladder necrosis with a foreign material (coil) in one arterial lumen.

Acute Bladder Necrosis after Pelvic Arterial Embolization for Pelvic Trauma: Lessons Learned from Two Cases of Immediate Postembolization Bladder Necrosis

“…The bladder vascular supply derives from the anterior trunk of the internal iliac artery, which gives way to the superior and inferior vesical arteries. Prior literature has discussed known sequelae and has identified injuries to the bladder resulting in necrosis of bladder tissue due to decreased perfusion from these vessels [ 2 , 4 , 5 , 7 , 8 ]. A retrospective study by Matityahu et al examined complications after pelvic angiographic embolization.…”

“…Bladder necrosis has been previously described as a delayed complication of pelvic arterial embolization, typically occurring 4-5 weeks after the procedure [ 2 , 6 ]. Our reported cases differ in the acuity of this finding, which presented as early as two weeks after the initial trauma.…”

“…Bladder necrosis is a result of embolization of the internal iliac or hypogastric arteries, unilateral or bilateral, with necrosis typically identified several weeks after the initial injury. Various cases of subacute bladder necrosis after embolization have been reported in the literature, typically four weeks after embolization [ 2 , 6 ]. We report two cases of acute bladder injury with bladder neck necrosis identified during the initial operative evaluation and within the early postprocedural period in patients with significant pelvic trauma requiring pelvic vascular embolization.…”

Bladder wall and surrounding tissue necrosis following bilateral superselective embolization of internal iliac artery branches due to uncontrollable haematuria related to bladder tumor: case report

“…Recently, superselective embolization became the method of choice to control such bleeding. Besides, physicians choose embolization among other methods of treatment for acute bleeding: combined trauma with pelvic fractures, uncontrollable bleedings after gynecological surgical operations and complications of radiotherapy (may be chronic as well) (Agolini et al, 1997; Matityahu et al, 2013; Ali et al, 2014; Sieber, 1994; Samuel Washington & Benjamin, 2016; El-Shalakany, 2003). Usually, sequence of actions comprises bilateral diagnostic angiography of internal iliac arteries in order to determine a source of bleeding (arterial supply of bladder tumors can originate from superior and/or inferior vesical arteries, prostatic arteries, not infrequently it may be branches of internal pudendal artery, obturator arteries (Vikash Prasad, 2009)) followed by superselective embolization using various embolic agents.…”

Organ-Protective Effects of Red Wine Extract, Resveratrol, in Oxidative Stress-Mediated Reperfusion Injury

“…Urinary bladder I/R injury is associated with vascular atherosclerotic disease or pelvic embolization operations [ 159 , 160 ]. Bladder ischemia could result in detrusor contractility impairment and bladder dysfunction [ 161 , 162 ].…”