Ureteral penetration caused by drilling during internal pelvic bone fixation: delayed recognition

Area of Science:

• Urology
• Orthopedic Surgery
• Surgical Complications

Background:

• Pelvic bone fractures often require surgical intervention.
• Internal fixation with screws is a common treatment for pelvic fractures.
• Ureteral injuries are potential, though uncommon, complications in pelvic surgery.

Purpose of the Study:

• To report a unique case of ureteral penetration during pelvic fracture surgery.
• To highlight the importance of anatomical awareness during orthopedic pelvic procedures.
• To emphasize the potential for ureteral injury from bone drilling techniques.

Main Methods:

• A case study of a 49-year-old male patient with pelvic fractures.
• Internal fixation using metal screws for multiple pelvic bone fractures.
• Surgical management involving ureteral segment excision, ureteroureterostomy, and double J stent placement.

Main Results:

• Profuse serous fluid discharge from a Penrose drain indicated a complication.
• A penetrating injury to the right distal ureter was identified.
• Successful surgical repair of the ureteral injury was performed.

Conclusions:

• Penetrating ureteral injury caused by bone drilling during pelvic surgery is a previously unreported complication.
• Orthopedic surgeons performing pelvic surgery must be aware of the ureter's anatomical location.
• Vigilance for and prompt management of ureteral injuries are crucial in pelvic trauma surgery.