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Sat Oct 27 11:38:01 BST 2007

Members,

I would appreciate your opinion on the following 'theoretical' scenario,
which might have happened in St. Elsewhere:

36 yrs old male, motor bike accident, car pulled out in front of them and he
came off his bike, cartwheeled several times. No LOC, haemodynamically
stable. Transported to a local unit, fluid resuscitated with
crystalloids, pelvic disruption suspected (pelvis secured - temporary),
catheter inserted, some blood but urinary flow established. CT - disruption
of symphysis, sliver of gas retroperitoneum mid rectum, tracking anteriorly
to left thigh and anterior abdominal wall on the left, moderate pelvic
haematoma

Patient transferred to tertiary care: second CT 8 hrs after, findings much
the same, no change in haematoma, no intra-abdominal mischief. Patient
hypotensive (98/60, pulse 102) - resuscitated. My questions are:

1. Pelvic fracture + suspected ongoing retroperitoneal venous bleed, what
surgical strategy would you employ?
2. If a rectal tear is suspected, without any perineal trauma, how would you
de-function, loop colostomy? Or end colostomy and mucous fistula? Would you
try and establish the site of perforation - on-table flexible sigmoidoscopy
etc.?

Details of op-findings later.

Best Wishes,
Saboor Khan
Coventry
UK

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Pelvic fracture