Internal Pudendal Artery Injury and Bleeding Into the Corpora Cavernosum Due to Complex Open Book Pelvic Fracture

Abstract

Open book fractures frequently occur in road traffic accidents and are often associated with organ injuries, soft tissue damage, and urogenital trauma. Pelvic fractures can vary in severity, with some being stable and others involving significant structural disruption. A 32-year-old man presented with severe lower abdominal and right lower limb pain following a road traffic accident. He remained alert and denied loss of consciousness but exhibited tachycardia. Examination revealed lower abdominal tenderness, pelvic swelling, bruising, and a scrotal hematoma. CT imaging showed extensive pelvic fractures involving the sacral promontory and right sacral ala, along with bladder rupture and urethral injury. He underwent urgent pelvic external fixation and exploratory laparotomy with bladder repair. Postoperatively, he developed hypovolemic shock, requiring ICU admission, fluid resuscitation, and blood transfusion. Intensive monitoring and conservative management stabilized his condition, allowing for additional surgical procedures. Despite the severity of his injuries, he showed signs of recovery, with stabilized vital signs and reduced pelvic swelling. Continued medical and supportive care underscored the importance of timely and comprehensive management in severe pelvic trauma cases. Bladder trauma is a serious complication of pelvic injuries, ranging from minor contusions to complete rupture. These injuries require prompt recognition and surgical intervention. Damage often occurs due to force transmission to the bladder, especially when it is full, leading to increased pressure and potential rupture. Given its location near the pelvic bones, the bladder is at a higher risk of injury in severe trauma. Symptoms may include lower abdominal pain, swelling, bruising, and signs of circulatory distress. Imaging helps assess the extent of injury and guides surgical management. Timely intervention is essential to prevent complications such as infection and long-term dysfunction. A multidisciplinary approach, vigilant monitoring, and aggressive management of complications are key to optimizing recovery in complex pelvic trauma cases.

Keywords: bladder trauma; hemodynamic instability (hdi); open pelvic fracture; pelvic hemorrhage; road traffic accident.

Figure 1. Anterior and anterior inferior defect in the urinary bladder wall with extraperitoneal contrast extravasation, leaking along the anterior abdominal wall, multiple blood clots in the urinary bladder, and a small amount of contrast in the left paracolic gutter

Impression: Combined intraperitoneal and extraperitoneal bladder rupture and associated urethral injury

Figure 2. Fractures of the sacral promontory and right sacral ala and widening of the right sacroiliac joint and pubic symphysis

Impression: Combined intraperitoneal and extraperitoneal bladder rupture and associated urethral injury