Non-urogenital abdominal complications associated with fractures of the pelvis

Summary

Early intra-abdominal complications in association with fractures of the pelvis were observed in 101 patients (54.3%. These were mild in 21 patients (11.3‰), moderate in 50 (26.9%) and severe in 40 (16.1%); in 25 of the latter (13.4%) laparotomy was required. The high incidence rate of these complications should alert clinicians to their importance.

At laparotomy the findings were rupture of the liver in 3 patients (1.6%), rupture of the spleen in 3, rupture of the liver and spleen in 4 (2.2%), rupture of the gut in 3, rupture of pelvic mesocolon in one (0.5%) and rupture of the diaphragm in one. In each there was retroperitoneal haemorrhage of varying extent. In 10 patients (5.4%) excessive amounts of retroperitoneal haemorrhage were present as the only lesion.

Extended retroperitoneal haemorrhage as the only lesion was found more commonly in association with Type V fractures (displaced on one or both sides); 60%, and in 30% of these cases the fracture of the pelvis was of the Malgaigne type.

Injuries of abdominal organs could not be correlated with the type of fracture of the pelvis, but rather to the causative injury. They were responsible for the death of 5 patients; the remaining 3 deaths were attributed to excessive retroperitoneal haemorrhage.

Paralytic ileus in association with pelvic fractures, was attributed to irritation of the autonomic nervous system, retroperitoneal haemorrhage or referred pain from lacerated muscles of the back combined with a fracture of the lumbar transverse processes.

Late complications in the form of hernia was attributed to detachment of the abdominal muscles from their pelvic attachment because of the fracture or the causative injuries.