Chronic bladder entrapment and bowel herniation after traumatic symphysis pubis diastasis
- VernacularTitle:陈旧性耻骨联合分离继发膀胱脱垂及腹壁疝
- Author:
Jian JIA
;
Jiageng CHEN
;
Jian TAN
- Publication Type:Journal Article
- Keywords:
Pelvis;
Fractures, old;
Small bowel hernia;
Fracture fixation, internal
- From:
Chinese Journal of Orthopaedics
1999;0(04):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical features and operative treatment of chronic bladder entrapment and bowel herniation after traumatic symphysis pubis diastasis. Methods One patient of late pelvic posttraumatic mal-alignment as Tile C2 type, which was associated with serious symphysis separation and combination of chronic bladder entrapment and bowel herniation, was admitted to our hospital in August 2002. The X-ray, three-dimensional CT reconstruction, MRI, and the bladder cystography were performed respectively in order to confirm the conditions. With the usage of ilioinguinal approach, the symphysis pubis diastasis was exposed and restored firstly; then, the malunion site of the left iliac was corrected; finally, after the reduction and internal fixation of the pelvis, the bowel herniation was resolved and the inferior abdominal wall defect was repaired with artificial materials. During the operation, the abnormal conditions were ob-served as follow: 1) The distance of symphysis pubis separation was about 7.5 cm; 2) the full-thick of the ectus abdominis was torn longitudinally tear along the middle line, and the transversalis fascia was fibrosis and adhered to the peritoneum, which consisted of hernia capsule; 3) the small bowel had been entrapped over the bladder through the gap of rectus abdominis and the right Hesselbach triangle. Results The pa-tient was followed up of 6 months. The limb discrepancy had been corrected satisfactory with a sound frac-ture healing and a good gait recovering after operation. The urinary function has recovered with a normal ap-pearance of penis. The patient felt stronger then to relieve the bowels than he did preoperatively. The erected dysfunction did not improve postoperatively. Conclusion The combined osteotomy and rigid fixation through anterior and posterior pelvic ring in the same stage is an effective method to close the symphysis seperation, decrease the volume of pelvic cavity, construct the pelvic floor indirectly, repair the inferior ab-dominal wall defect, cure the bowel herniation, and improve the bladder entrapment.
