Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe lower abdominal pain following blunt pelvic trauma. Reports inability to void, gross hematuria, and progressive abdominal distension. Associated symptoms include nausea, vomiting, and signs of peritoneal irritation. History significant for recent pelvic fracture or high-energy deceleration injury.
Clinical Examination Findings
Abdominal examination reveals diffuse tenderness, guarding, and rebound tenderness consistent with chemical peritonitis. Bowel sounds are diminished. Suprapubic dullness noted on percussion. Digital rectal exam may reveal high-riding prostate or pelvic instability. Vital signs show tachycardia and hypotension suggestive of associated hemorrhage or sepsis.
Treatment Protocol
Immediate surgical consultation for exploratory laparotomy and primary bladder repair. Placement of large-bore urethral catheter for continuous bladder drainage. Initiation of broad-spectrum intravenous antibiotics and fluid resuscitation. Serial monitoring of electrolytes (specifically creatinine and potassium) to assess for pseudo-renal failure due to intraperitoneal urine reabsorption.