Pelvic fracture - operative findings

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Thanks to those who replied: Just to mention a few points:

1. I agree, with such an injury a urethrogram should have been performed.
2. Cannot comment on whether the crystalloid resuscitation was excessive.
3. The CT scan did not show a blush, however my (experienced) orthopaedic
colleague, who has an interest in pelvic trauma, was concerned because of
his hypotension - and wondered about packing - I hadn't performed one
before!). I did not think that there was substantive evidence of a bleed.
4. A rigid sigmoidoscopy was performed, pre-op and he had blood in the
rectum.
5. Just curious, what is a 'VOMIT' as described by k?

Intra-op findings (antibiotics administered );

Gen Surg - low midline laparotomy - pristine abdominal cavity, some bruising
at peritoneal reflection, paused.

Orthopaedic: complete diastasis as soon as the support was released, the
pelvis 'sprung' open, instantly held together by orthopaedic 'tongs'. Brisk
venous ooze, welling up, retro-peritoneum either side of bladder - tightly
packed - haemsotatic plugs and gauze, exactly as described by Olav and
yes, 'surprisingly easy' and very effective, even for a novice. Site of
subcutaneous emphysema identified - copious lavage.

Gen Surg-  Sigmoid loop mobilised and brought to the surface, Abdomen
closed. lithotomy position, stoma matured, distal sigmoid copious washout
with bladder catheter (balloon inflated). Rigid sigmoidoscopy repeated -
small 'rent' in anterior rectum, haemostatic plugs just about visible! No
further attempt at repair.

Day 2, patient awake, stable, plan to revisit / review and remove pack
tomorrow.

Criticism: Would an end stoma, mucous fistula be a better option  (complete
defunctioning)?

Finally, impressed with the practicality and ease of packing, a worthy
damage limitation technique.

Best Wishes,
Saboor Khan
Coventry
UK

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