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Does the intrapelvic compartment syndrome exist?

M Hessmann1, P Rommens

  • 1Department of Traumatology, University Hospitals of the Johannes-Gutenberg-University, Mainz, Germany.

Acta Chirurgica Belgica
|April 16, 1998
PubMed
Summary

Intrapelvic compartment syndrome, a rare condition, can cause anuria and renal failure due to pelvic fractures compressing ureters. Prompt surgical intervention to stabilize fractures and evacuate hematomas is crucial for treatment.

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Area of Science:

  • Urology
  • Trauma Surgery
  • Orthopedic Surgery

Background:

  • Pelvic compartment syndrome is a rare condition characterized by elevated intra-compartmental pressure.
  • The gluteal compartments are most commonly affected in pelvic compartment syndromes.
  • Intrapelvic compartment syndrome specifically involves ureteral compression within the true pelvis.

Observation:

  • Three patients presented with bilateral ureteral obstruction and anuria with renal failure.
  • This obstruction was caused by massive retroperitoneal hematomas secondary to unstable pelvic ring or acetabular fractures.
  • Anuria developed 24-48 hours post-injury, necessitating differentiation from other causes like hypovolemic shock.

Findings:

  • Bilateral ureteral compression by retroperitoneal hematomas constitutes an intrapelvic compartment syndrome.
  • Temporary management with bilateral tube nephrostomy is suboptimal.
  • Effective treatment involves fracture stabilization and surgical evacuation of the hematoma to decompress the ureters.

Implications:

  • Prompt diagnosis and surgical management are essential for treating intrapelvic compartment syndrome.
  • Surgical revision includes hematoma evacuation, ureteral decompression, and potential bleeding point ligation.
  • Internal fracture fixation can be performed concurrently if the patient is hemodynamically stable, with a potential need for a second look procedure.

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