Trauma to the Pelvis: Injuries to the Rectum and Genitourinary Organs

Abstract

Pelvic trauma is associated with high mortality rates. Blunt pelvic injuries from high-energy mechanisms are often associated with pelvic fractures and injuries to the rectum and genitourinary (GU) tract. In addition, due to close anatomic proximity, penetrating pelvic trauma can injure the bony pelvis, rectum, and GU tract concomitantly. As a result, the assessment and management of pelvic trauma requires a multifaceted approach involving orthopedics, trauma surgery and urology.

Autotransplantation of autologous adipose tissue‐derived mesenchymal stem cells to treat complex fistula‐in‐ano – the FLiRT technique ‐ a video vignette

“…This means there is a growing cohort of patients suffering pouch failure (the incidence being 10% at 10 years). For patients in whom an ileostomy alone is inadequate or inappropriate, pouch excision is required [1]. Most surgeons rarely perform this difficult operation but the high volume at St Mark's has led to the development of a reproducible, stepwise approach (Video S1) [2].…”

Penetrating pelvic trauma: Initial assessment and surgical management in emergency

“…The integrity of the bladder neck must also be checked. Bladder drainage should be performed by a Foley urethral catheter or a suprapubic catheter [58]. Devitalized wound edges are sharply debrided and single-layer closure of the bladder wall is performed with 0 Vicryl sutures that do not include the prevesical fat.…”

“…Delayed repair for wounds of the lower ureter must meet several surgical imperatives: preservation of vascularization during ureteral mobilization, excisional debridement of devitalized tissue, and repair ''without tension'' stented by a double-J ureteral catheter [58]. For a ureteral defect too long to close without tension, ureteral re-implantation is required with or without anti-reflux tunnelling into the posterior bladder wall [77].…”

Les traumatismes pénétrants du pelvis : accueil, bilan et prise en charge chirurgicale en urgence

“…On vérifiera également l'intégrité du col vésical. Le drainage de la vessie doit être réalisé par une sonde vésicale ou un cathéter suspubien [58]. On effectuera le débridement-parage des tissus dévitalisés, puis une fermeture étanche, en un seul plan, avec du Vicryl 0, et ne prenant pas la graisse prévésicale.…”

“…La prise en charge différée des plaies du bas uretère doit répondre à plusieurs impératifs chirurgicaux : une mobilisation urétérale préservant la vascularisation, le débridement-parage des tissus dévitalisés et une réparation « sans tension » sur sonde urétérale de type JJ [58]. En cas de perte de substance, la prise en charge passe alors par une réimplantation urétérovésicale, avec ou sans système antireflux, avec généralement vessie psoïque [77].…”