Complete Urethral Transection , 16 Year Old Male

16year old boy was riding a motor bike.He hit a pot hole bounced off the bike and crushed onto the ground several meters away. Patient was admitted at Kintampo 5 hours from Kumasi, with mild abdominal pain, pelvic pain, inability to walk. He was found to have the following injuries
1. Pelvic diastasis, fractures of both superoir rami
2. Suspected bladder injury (bloody urine)
3. Abrassions of Right posterolateral abdomen
Patient was progressively became  pale   developed gradual onset of peritonitis and was referred after haemotransfusion, to KATH, Kumasi
Examinations:  Pale ill looking, RR 20cpm, Bp 110/60mmHg Pulse 120bpm, : Head neck chest normal , Abdomen generally tender , pelvic compression tenderness positive, palpable gap at suprapubis
Urethral catheter insitu .drainage bag 200mls frank blood in 24 hrs. Swollen suprapubis, penis, scrotum, proximal thigh .
Diagnosis : 1. Extraperitoneal bladder/ urethral injury
2. Generalised peritonistis seconary to blunt abdominal injury
Investigations :Labs potassium 7.9  ,  Creat high urea high,
FAST is positive
Pelvic xray showed pelvic diastasis
Preoperative :
Decision to stabilize myocardium with calcium gluconate
Start  insulin glucose infusion
Trauma laparotomy with urologists
Surgery : Trauma Laparotomy, bladder opened
 Intraoperative Findings:
1. 5 litres  of urine in intra and extraperitoneal space
2 : Complete transection of posterior urethra
3. Bladder and ureters normal,
4.: Serosal tears at rectosigmoid
5.Contussion of splenic flexure, hepatic flexure and descending colon
Serosal tears repaired
Railroading of the urethra done, suprapubic cystostomy done by urologist
Postoperative state :
Severe resp  depression ,
Pulmonary oedema developed during surgery resolved post op on iv lasix
Patient was on ventilator for 2 days at ICU.
Pelvic fractures managed by trauma /orthopaedics
Subsequently made full recovery
Credits : Drs Azorliade (Urologist) , Antwi (Senior Resident), Ametih