전복막출혈이 동반된 골반골절

Pelvic Bone Fracture with Preperitoneal Hemorrhage

  • Kim, Joong Suck (Department of Surgery, Eulji University Hospital) ;
  • Sul, Young Hoon (Department of Surgery, Eulji University Hospital) ;
  • Go, Seung Je (Department of Surgery, Eulji University Hospital) ;
  • Ye, Jin Bong (Department of Surgery, Eulji University Hospital) ;
  • Park, Sang Soon (Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital) ;
  • Ku, Gwan Woo (Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital) ;
  • Kim, Yeong Cheol (Department of Surgery, Eulji University Hospital)
  • 투고 : 2015.10.30
  • 심사 : 2015.12.11
  • 발행 : 2015.12.31

초록

Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding. We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission.

키워드

참고문헌

  1. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fracture: epidemiology and predictors of associated abdominal injureis and outcomes. J Am Coll Surg 2002; 195: 1-10. https://doi.org/10.1016/S1072-7515(02)01197-3
  2. Sanchez-Tocino JM, Turegano-Fuentes F, Perez-Diaz D, Sanz-Sanchez M, Lago-Oliver Zorrilla-Ortuzar J, et al. Severe pelvic fractures, associated injuries and hemodynamic instability: incidence, management and outcome in our center. Cir Esp 2007; 81: 316-23. https://doi.org/10.1016/S0009-739X(07)71330-1
  3. Park KC. Pelvic Fracture Issues. J Korean Fract Soc 2010; 23: 341-5. https://doi.org/10.12671/jkfs.2010.23.3.341
  4. Zhang P, Zhou DS, Hu JM, Zou DS, Li LX, Mu WD. Management of hemodynamically unstable pelvic fracture in pregnancy: a case report and review of literature. Chinese journal of traumatology 2012; 15: 234-7.
  5. Burlew CC, Moore EE, Smith WR, Johnson JL, Biffl WL, Barnett CC, et al. Preperitoneal Pelvic Packing/ External Fixation with Secondary Angioembolization: Optimal Care for Life-Threatening Hemorrhage from Unstable Pelvic Fractures. J Am Coll Surg 2011; 212: 628-37. https://doi.org/10.1016/j.jamcollsurg.2010.12.020
  6. Metsemakers WJ, Vanderschot P, Jennes E, Nijs S, Heye S, Maleux G. Transcatheter embolotherapy after external surgical stabilization is a valuable treatment algorithm for patients with persistent haemorrhage from unstable pelvic fractures: Outcomes of a single centre experience. Injury 2013; 44: 964-8. https://doi.org/10.1016/j.injury.2013.01.029
  7. Velmahos Gc, Toutouzas KG, Vassiliu P, Sarkisyan G, Chan LS, Hanks SH, et al. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. The Journal of trauma 2002; 53: 303-8. https://doi.org/10.1097/00005373-200208000-00019
  8. Balogh Z, Caldwell E, Heetvled M, et al: Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma 2005; 58: 778-82. https://doi.org/10.1097/01.TA.0000158251.40760.B2