2012 Volume 26 Issue 4 Pages 426-430
A 69-year-old man injured in a truck accident was admitted to our hospital in shock and underwent iliac artery embolization and external fixation for an unstable pelvic fracture. We performed retrograde cystography and intravenous urography but no injury of the urinary system was apparent. On hospital day 10, computed tomography showed abscesses on both thighs and cystography showed leakage of contrast media from the bladder into both thighs. We debrided the bladder circumference in both femoral regions and corrected the bladder injury, but suture rupture occurred. Because leakage persisted, we constructed bilateral ureterocutaneous fistulas on day 42 and the patient was transferred to a rehabilitation hospital on day 85. Physicians should be cognizant that extraperitoneal bladder injury requiring surgical repair may not be detected by diagnostic imaging tests on admission, and repeat examination should be performed in patients with persistent hematuria.
