Question
What should be the subsequent course of action in the management of a 30-year-old male patient who has suffered a pelvic fracture due to blunt abdominal trauma, with no blood observed at the meatus, and catheterization yielding minimal urine output, as depicted in the provided radiological image?
| A. |
Suprapubic cystostomy
|
| B. |
Per Urethral catheterization
|
| C. |
Laparotomy
|
| D. |
Pelvic packing along with B/L percutaneous nephrostomy
|
Show Answer
|
Correct Answer » A
Explanation
|
|
The CT image shows:
- Pelvic fracture
- Contrast extravasation confined around the bladder/pelvic region
- No clear outlining of bowel loops or free intraperitoneal contrast
These findings are more consistent with:
Extraperitoneal bladder rupture
Extraperitoneal ruptures are:
- More common with pelvic fractures
- Usually due to bony fragment injury to bladder base/anterior wall
Management of Extraperitoneal Bladder Rupture
Standard treatment:
- Foley catheter drainage for 10–14 days
However, if options are limited and urethral injury or ineffective drainage is suspected:
- Suprapubic cystostomy is appropriate
Since:
- Catheterization yielded minimal urine
- Pelvic trauma present
- Persistent concern for lower urinary tract injury
The best answer among the options becomes: A. Suprapubic cystostomy
Why Other Options Are Incorrect
B. Per urethral catheterization
- Already attempted
- Minimal urine obtained
- Not adequate here
C. Laparotomy
- Required for intraperitoneal rupture
- Not indicated for uncomplicated extraperitoneal rupture
D. Pelvic packing with bilateral nephrostomy
- Reserved for severe pelvic hemorrhage or upper tract diversion
- Not standard here
