Vesico-Acetabular Fistula and Urolithiasis in the Hip Joint Cavity due to Persistent Bladder Entrapment after Acetabular Fracture

Abstract

We report a rare case of vesico-acetabular fistula due to an improperly treated pelvic fracture with urinary stone formation in the joint cavity. This complication was related to an unrecognized mechanism of bladder wall entrapment in the acetabular floor defect during weight bearing. This situation led to several mistreatment decisions in our case and should be always considered by urologists dealing with patients after major pelvic trauma. In this case report, we analyze the publications related to this problem, discuss the main mechanisms of bladder wall damage after acetabular fracture, and propose tips for diagnosis and treatment.

Central acetabular fracture dislocations: Are existing classifications comprehensive?

“…In conclusion, none of the presented CAFD classifications was found to be ideal as none was able to completely describe the extent of intrapelvic displacement of the femoral head, the variety of associated trauma, the reproducibility by intra-and interobserver reliability assessments nor the inclusion of alterations in [62] 1976 -Case report --Small bowel rupture --Verdonk [39] 1984 -40 --Sciatic nerve deficit 2 5 Connolly [49] 1986 -Case report --Sciatic nerve deficit --Bacarese [48] 1991 -Case report --Small bowel herniation (fatal) --Hughes [16] 2000 Case report --Pelvic haemorrhage (fatal) --Tolkach [47] 2011 -Case report --Bladder wall entrapment -- [58] 2008 -Case report -1 Neck of femur --Barrett [44] 2009 -Case report -1 Intertrochanteric --trauma appearance. In our opinion, existing classifications about CAFD are not reliable, comprehensive or contemporary.…”

“…Associated abdominal, urogenital or soft-tissue injuries were not included in any of the identified CAFD classification although these injuries were common [10,16,39,[47][48][49][50][51][52][53]62,67,69] and occasionally fatal [16,48,50].…”

“…in cases with additional fractures of the proximal femur [11,17,44,[54][55][56][57][58]69]) or (iii) the need for an escalation of diagnostic means as well as an interdisciplinary preoperative planning to address associated injuries (e.g. soft-tissue injury, abdominal or urogenital trauma [10,16,39,[47][48][49][50][51][52][53]62,67,69]). In summary, using these classifications of acetabular fractures [9,79] for the description of CAFD it appears to be inadequate.…”

“…Abdominal trauma with a small bowel herniation or rupture, is reported in four case reports [48,50,51,62] whereas one original article describes an incidence of 3% for large bowel herniation [67]. One article reported about bladder rupture [53] which occurred with an incidence of 5% whilst another commented on a bladder wall entrapment [47] into the hip joint which resulted in an established vesicoacetabular fistula. Comminuted fracture with a mild to moderate central displacement of the femoral head and of the acetabular fragments Grade 3…”

“…Finally, 13 [10,16,39,[47][48][49][50][51][52][53]62,67,69] articles (seven of 13 being case reports) report about non-orthopaedic injuries associated with CAFD and are listed in Table 4. Nerve injuries are reported with sciatic nerve deficits being observed in the range of 5-18% [10,39,52,69].…”