Abstract
A 20-year-old male was found lying in front of a condominium in the early morning. Judging from his condition, he had fallen from the 4th floor, and he was transported to our hospital. On arrival, he was stupefied and restless. Laboratory tests showed metabolic acidosis and marked hyperglycemia (1520 mg/dL), and his blood pressure was gradually decreasing. Further evaluation showed intra-abdominal bleeding, and fractures of the sacrum and T12 vertebra. Bladder rupture was suspected due to noted hematuria with clots, and an emergency laparotomy was performed. Intra-abdominal inspection revealed bladder rupture and arterial bleeding. After hemostasis and bladder wall repair, retroperitoneal hematoma was enlarged, and angiography was performed after laparotomy. Transcatheter arterial embolization was performed for the left and right lateral sacral arteries and the left obturator artery. The HbA1c was 5.9% and diabetes-related autoantibodies were negative; fulminant type I diabetes was diagnosed. The patient had most likely fallen and injured himself due to impaired consciousness associated with diabetic ketoacidosis. With both conditions, this patient's trauma-related stress probably exacerbated the hyperglycemia. However, even with coexisting fulminant type I diabetes, early volume resuscitation and glycemic control with insulin have no major complications in the course of traumatic injury.
