Pelvic Trauma: Vascular/Visceral

  • Stefano Giannecchini
  • Valentina Caturano
  • Carmelo Rende
  • Viola Valentini
  • Margherita Trinci
  • Vittorio Miele


For a long time, complication of pelvic fractures has been described as associated injuries, emphasizing on fracture classification. Indeed, the enormous amount of energy that determines a pelvic ring fracture is also often the cause of severe and life-threatening visceral and multiorgan injuries, which must be promptly recognized before any detailed fracture evaluation and classification. Though over the years treatment of vascular and visceral injuries has been greatly improved, bleeding remains a dreadful complication and other acute lesions, such urological and neurological injuries or bowel entrapment, have still devastating consequences. In this chapter, we offer the radiologist a diagnostic management guide to identify the most significant visceral injuries associated with pelvic trauma but at the same time we want you to increase your awareness of these complications that, if ignored, lead to poor outcomes.


Pelvis Trauma Hemorrhage Complications Diagnosis 


  1. 1.
    Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012;265(3):678–93.CrossRefGoogle Scholar
  2. 2.
    Papakostidis C, Kanakaris N, Dimitriou R, Giannoudis PV. The role of arterial embolization in controlling pelvic fracture haemorrhage: a systematic review of the literature. Eur J Radiol. 2012;81(5):897–904.CrossRefGoogle Scholar
  3. 3.
    McCormack R, Strauss EJ, Alwattar BJ, et al. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis. 2010;68(4):281–91.PubMedGoogle Scholar
  4. 4.
    Kertesz JL, Anderson SW, Murakami AM, et al. Detection of vascular injuries in patients with blunt pelvic trauma by using 64-channel multidetector CT. Radiographics. 2009;29(1):151–64.CrossRefGoogle Scholar
  5. 5.
    Galluzzo M, Buquicchio GL, Gaudino F, Ianniello S, Leone A, Trinci M, Miele V. Traumi del cingolo pelvico: Pictorial essay. Il Giornale Italiano di. Radiol Med. 2016;3:46–57. doi: 10.17376/girm_3-1-01022016-7.CrossRefGoogle Scholar
  6. 6.
    Miele V, Di Giampietro I (2014) Diagnostic Imaging in Emergency. Salute e Società (2EN):127–38. doi: 10.3280/SES2014-002010EN.
  7. 7.
    Romano L, Pinto A, Niola R, et al. Bleeding due to pelvic fractures in female patients: pictorial review of multidetector computed tomography imaging. Curr Probl Diagn Radiol. 2012;41(3):83–92.CrossRefGoogle Scholar
  8. 8.
    Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5.CrossRefGoogle Scholar
  9. 9.
    Baghdanian AH, Armetta AS, Baghdanian A, et al. CT of major vascular injury in blunt abdominopelvic trauma. Radiographics. 2016;36(3):872–90.CrossRefGoogle Scholar
  10. 10.
    Slater SJ, Barron DA. Pelvic fractures-a guide to classification and management. Eur J Radiol. 2010;74(1):16–23.CrossRefGoogle Scholar
  11. 11.
    Pieri S, Agresti P, Buquicchio GL, DI Giampietro I, Trinci M, Miele V. Endovascular management of the rectus muscle hematoma. Radiol Med. 2015;120(10):951–8. doi: 10.1007/s11547-015-0516-2.CrossRefPubMedGoogle Scholar
  12. 12.
    Patlas MN, Dreizin D, Menias CO, et al. Abdominal and pelvic trauma: misses and misinterpretations at multidetector CT: trauma/emergency radiology. Radiographics. 2017;37(2):703–4.CrossRefGoogle Scholar
  13. 13.
    Hamilton JD, Kumaravel M, Censullo ML, et al. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics. 2008;28(6):1603–16.CrossRefGoogle Scholar
  14. 14.
    Ramchandani P, Buckler PM. Imaging of genitourinary trauma. AJR Am J Roentgenol. 2009;192(6):1514–23.CrossRefGoogle Scholar
  15. 15.
    Avey G, Backmore CC, Wessells H, et al. Radiographic and clinical predictors of bladder rupture in blunt trauma patients with pelvic fracture. Acad Radiol. 2006;13(5):573–9.CrossRefGoogle Scholar
  16. 16.
    Baverstock R, Simons R, McLoughlin M. Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre. Can J Urol. 2001;8(5):1372–6.PubMedGoogle Scholar
  17. 17.
    Smith J, Caldwell E, D’Amours S, et al. Abdominal trauma: a disease in evolution. ANZ J Surg. 2005;75(9):790–4.CrossRefGoogle Scholar
  18. 18.
    Yao DC, Jeffrey RB Jr, Mirvis SE, et al. Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution. AJR Am J Roentgenol. 2002;178(1):17–20.CrossRefGoogle Scholar
  19. 19.
    Gomez RG, Ceballos L, Coburn M, et al. Consensus statement on bladder injuries. BJU Int. 2004;94(1):27–32.CrossRefGoogle Scholar
  20. 20.
    Sandler CM, Goldman SM, Kawashima A. Lower urinary tract trauma. World J Urol. 1998;16(1):69–75.CrossRefGoogle Scholar
  21. 21.
    Kane NM, Francis IR, Ellis JH. The value of CT in the detection of bladder and posterior urethral injuries. AJR Am Roentgenol. 1989;153(6):1243–6.CrossRefGoogle Scholar
  22. 22.
    Quagliano PV, Delair SM, Malhotra AK. Diagnosis of blunt bladder injury: a prospective comparative study of computed tomography cystography and conventional retrograde cystography. J Trauma. 2006;61(2):410–21.CrossRefGoogle Scholar
  23. 23.
    Fu CY, Teng LH, Liao CH, et al. The diminishing role of pelvic stability evaluation in the era of computed tomographic scanning. Medicine (Baltimore). 2016;95(16):e 3421.CrossRefGoogle Scholar
  24. 24.
    Koraitim MM. Pelvic fracture urethral injuries: evaluation of various methods of management. J Urol. 1996;156:1288–91.CrossRefGoogle Scholar
  25. 25.
    Ingram MD, Watson SG, Skippage PL, et al. Urethral injuries after pelvic trauma: evaluation with urethrography. Radiographics. 2008;28(6):1631–43.CrossRefGoogle Scholar
  26. 26.
    Goldman SM, Sandler CM, Corriere JN Jr, et al. Blunt urethral trauma: a unified, anatomical mechanical classification. J Urol. 1997;157(1):85–9.CrossRefGoogle Scholar
  27. 27.
    Schmidek HH, Smith DA, Kristiansen TK. Sacral fractures. Neurosurgery. 1984;15(5):735–46.CrossRefGoogle Scholar
  28. 28.
    Garozzo D, Zollino G, Ferraresi S. In lumbosacral plexus injuries can we identify indicators that predict spontaneous recovery or the need for surgical treatment? Results from a clinical study on 72 patients. J Brachial Plex Peripher Nerve Inj. 2014;9(1):1.CrossRefGoogle Scholar
  29. 29.
    Kekez T, Augustin G. Small bowel entrapment associated with pelvic fracture: a case report with review of the literature and differentiation of clinical picture. Eur J Emerg Med. 2012;19(1):60–1.CrossRefGoogle Scholar
  30. 30.
    Cleary RK, Pomerantz RA, Lampman RM. Colon and rectal injuries. Dis Colon Rectum. 2006;49(8):1203–22.CrossRefGoogle Scholar
  31. 31.
    Bondia JM, Anderson SW, Rhea JT, Soto JA. Imaging colorectal trauma using 64-MDCT technology. Emerg Radiol. 2009;16(6):433–40.CrossRefGoogle Scholar
  32. 32.
    Atri M, Hanson JM, Grinblat L, et al. Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology. 2008;249(2):524–33.CrossRefGoogle Scholar
  33. 33.
    Zong ZW, Bao QW, Liu HY, et al. Diagnosis and treatment of rare complications of pelvic fractures. Chin J Traumatol. 2016;19(4):199–205.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Stefano Giannecchini
    • 1
  • Valentina Caturano
    • 1
  • Carmelo Rende
    • 1
  • Viola Valentini
    • 1
  • Margherita Trinci
    • 1
  • Vittorio Miele
    • 2
  1. 1.Department of Emergency RadiologyS. Camillo HospitalRomeItaly
  2. 2.Department of RadiologyCareggi University HospitalFlorenceItaly

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