Early diagnosis and treatment of the pelvic fracture combined with abdominal organ injury

YANG Kun; WU Tian-hao; BAI Rui; YANG Yun-kang; GE Jian-hua; XIANG Fei-fan

doi:10.3969/j.issn.2095-252X.2018.02.003

Abstract：Objective To investigate the early clinical features of patients with the pelvic fracture combined with abdominal organ injury, in order to reduce missed diagnosis and complications, as well as to improve the early diagnosis and treatment success rate of the pelvic fracture combined with abdominal organ injury. Methods From June 2005 to June 2015, a retrospective study was performed on 102 patients with the pelvic fracture complicated with abdominal organ injury. There were 64 males and 38 females, aged 16 to 65 years with an average of ( 36.8 ± 6.6 ) years. From injury to admission: half an hour to 24 hours, with an average of ( 364.25 ± 17.35 ) min. According to Tile typing: 47 cases were of A, 32 cases of B and 23 cases of C. The trauma type of abdominal organs, clinical manifestations, complications, the misdiagnosis and treatment of abdominal visceral injury were analyzed to summarize the early diagnosis and treatment protocol of the pelvic fracture combined with abdominal organ injury. Results In this group, 84 cases were of intraperitoneal visceral organ rupture and 18 cases not. The average time of diagnosis confirmation was 6.5 hours after the injury. Laparotomy was performed on 72 cases and laparoscopy in 12 cases, among whom 3 cases were converted to the laparotomy because of severe hepatic rupture. Twelve cases received Stage I interventional embolization. Eighty-nine cases were cured, while 13 cases died ( 9 cases of traumatic hemorrhagic shock secondary to DIC, 1 case of septic shock, 2 cases of severe craniocerebral injury, 1 cases of pulmonary embolism ). The success rate of the treatment was 87.25%. Early missed diagnosis occurred in 2 cases, among whom 1 case combined with colonic rupture and died after the salvage and another 1 case was of intestinal obstruction rupture followed by small intestine embedded fracture ( 2 months postoperatively, start to heal ). Conclusions Patients with the pelvic fracture combined with abdominal organ injury are featured with complicated conditions, which are easy to be misdiagnosed and thus endangering patients' survival. The early diagnosis rate and success rate of the treatment can be improved by early analysis of the disease, improved comprehensive examination, timely anti-shock treatment and pelvic external fixation. Early abdominal exploration and damage control surgery should be considered when necessary.