Bilateral Ureteral Obstruction and Renal Failure Caused by Massive Retroperitoneal Hematoma: Is There a Pelvic Compartment Syndrome Analogous to Abdominal Compartment Syndrome?

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Abstract

Objectives:

To describe an intrapelvic compartment syndrome analogous to abdominal compartment syndrome and to characterize its diagnosis and treatment.

Design:

Retrospective analysis.

Setting:

Level I trauma center.

Patients:

Three patients with pelvic ring or acetabular fractures presented with bilateral ureteral obstruction, renal organ failure, and anuria due to direct compression of both ureters in the true pelvis by a massive retroperitoneal hematoma.

Intervention:

Surgical therapy consisted of fracture stabilization, decompression of the retroperitoneal space, and evacuation of the hematoma. Persistent isolated bleeding points were either embolized preoperatively or ligated.

Results:

After decompression, all three patients promptly recovered their renal organ function.

Conclusion:

An intrapelvic compartment syndrome can be defined as bilateral ureteral obstruction and renal failure caused by a massive intrapelvic hematoma with increased retroperitoneal pressure. Diagnostic differentiation of anuria in patients with pelvic ring or acetabular fractures must include intrapelvic compartment syndrome. Early diagnosis and treatment are mandatory.

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