Mr AI 42 , galamasey miner
- Pc : laceration to groins : 12hrs prior to presentation
- Fan belt tore off the machine in operation leading to groin and perineal injuries , immediately couldn’t walk, carried to nearly hospital where ivf, analgesics, encircling pelvic and thigh compressive dressing applied and referred
- Loc – no (head ,neck ,chest pains ) fever -, severe pain bleeding from sites of laceration at time of injury
- Not able to pass urine
- Stools nil
- Pmhx nil
- Dhx prescribed
- Examination :
- Afebrile , pale , fully conscious and well oriented
- Head n neck no tenderness, tpr pres in upper l, lower limbs not obj assessed
- Chest CC, no tenderness , moved symm
- Cvs : bp 139/82 mmHg , {Pulse 82 bpm , reg good v, spo2 96
- Lower limb pulses preserved
- Abd soft upper part , mocves with resp, no bruising over flanks, no renal angle ten
- Dre : normal anal sphincter tone , no other abnormality
- S/L: rt deep groin laceration 16cm , left 8cm ,left scrotal laceration.,perineal laceration , penile skin and dartos avulsion, pelvic comp tens pos
- Visibly Distended urinary bladder, test asp ..clear urine, palpable fractured pubis
- No blood at external urethral meatus
- Diagnosis : Deep groin laceration/ AROU 2 pelvic fracture urethral disruption
- Management summary
- blood transfusion
- Iv antib , tetanus prophylaxis, analgesic
- Wound toileting , suturing
- Urine diversion ( SPC )
- Pelvic xr, cxr, RUG , MCUG later
- EXTERNAL FIXATION
WOUND EXPLORATION
- Mild sedation
- Wound irrigation with saline
- Formal spc done
- Transinguinal rt orchidectomy done
- Extravesical space drained passively and wound closure done
- external fixation done by orthopaedic team . Patient doing well.
Dr Richard Ametih ( Urology resident ), KATH
Dr Opuni( Orthpopaedic resident ), KATH
