Research Article| Volume 18, ISSUE 6, P379-383, November 1987

Download started.


The use of peritoneal lavage and urological studies in major fractures of the pelvis—a reassessment

      This paper is only available as a PDF. To read, Please Download here.


      Fifty patients with major fractures of the pelvis (Trunkey's classification types I and II) treated in an urban Level I Trauma Center were analysed to assess the role of peritoneal lavage and urological studies in the initial evaluation. The mechanisms of injury were automobile v. pedestrian (44 per cent), falls from heights (44 per cent), and motor vehicular accidents (12 per cent). Important hypotension was present in 46 per cent of patients on arrival. Peritoneal tap or lavage was selectively used in 11 patients (22 per cent). Four patients in refractory hypotension despite vigorous resuscitation had positive results. There were no false-positive results or missed intra-abdominal injuries in any of the 50 patients. Laparotomy was carried out in 10 of 50 patients. IVP or cystography was performed in 25 of 50 patients. However, injuries of the urinary tract requiring operative correction (eight injuries in six patients) were all associated with gross haematuria. Urological studies were negative in patients with 1 to 3+ microscopic haematuria. Peritoneal lavage is recommended on a selective basis in patients with pelvic fractures. Microscopic haematuria does not warrant contrast studies of the urinary tract.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Brown J.J.
        • Green F.L.
        • McMillin R.D.
        Vascular injuries associated with pelvic fractures.
        Am. Surg. 1984; 50: 150
        • Federle M.P.
        • Crass R.A.
        • Jeffrey B.
        • et al.
        Computed tomography in blunt abdominal trauma.
        Arch. Surg. 1982; 117: 645
        • Fischer R.P.
        • Beverlin B.C.
        • Engrav L.H.
        • et al.
        Diagnostic peritoneal lavage: Fourteen years and 2586 patients later.
        Am. J. Surg. 1978; 136: 701
        • Flint L.M.
        • Brown A.
        • Richardson J.D.
        • et al.
        Definitive control of bleeding from severe pelvic fractures.
        Ann. Surg. 1979; 189: 709
        • Fortune J.B.
        • Brahme J.
        • Mulligan M.
        • et al.
        Emergency intravenous pyelography in the trauma patient.
        Arch. Surg. 1985; 120: 1056
        • Gilliland M.G.
        • Ward R.E.
        • Flynn T.C.
        • et al.
        Peritoneal lavage and angiography in the management of patients with pelvic fractures.
        Am. J. Surg. 1982; 144: 744
        • Goldstein A.S.
        • Sclafani S.
        • Kupferstein N.H.
        • et al.
        The diagnostic superiority of computerized tomography.
        J. Trauma. 1985; 25: 938
        • Griffen W.O.
        • Belin R.P.
        • Ernst C.B.
        • et al.
        Intravenous pyelography in abdominal trauma.
        J. Trauma. 1978; 18: 387
        • Guice K.
        • Oldham K.
        • Eide B.
        • et al.
        Hematuria after blunt trauma: When is pyelography useful?.
        J. Trauma. 1983; 23: 305
        • Houman B.
        • Fiore A.
        • Addonizio J.
        • et al.
        Diagnosis and management of associated urological injuries in patients with pelvic fractures: Poster session.
        in: American Urological Association Annual Meeting, Atlanta, GA, May 12–161985
        • Hubbard S.G.
        • Bivins B.A.
        • Sachatello C.R.
        • et al.
        Diagnostic errors with peritoneal lavage in patients with pelvic fractures.
        Arch. Surg. 1979; 114: 844
        • Murr P.C.
        • Moore E.
        • Lipscom R.
        • et al.
        Abdominal trauma associated with pelvic fracture.
        J. Trauma. 1980; 20: 919
        • Naam N.H.
        • Brown W.H.
        • Hurd R.
        • et al.
        Major pelvic fractures.
        Arch. Surg. 1983; 118: 610
        • Palmer J.K.
        • Benson G.S.
        • Corriere J.N.
        Diagnosis and initial management of urologic injuries associated with 200 consecutive pelvic fractures.
        J. Urol. 1983; 130: 712
        • Panetta T.
        • Sclafani S.
        • Goldstein A.
        • et al.
        Percutaneous transcatheter embolization for massive bleeding from pelvic fractures.
        J. Trauma. 1985; 25: 1021
        • Reynolds B.M.
        • Balsano N.A.
        • Reynolds F.X.
        Pelvic fractures.
        J. Trauma. 1973; 13: 1011
        • Scalea T.
        • Goldstein A.
        • Phillips T.
        • et al.
        An analysis of 161 falls from a height: the ‘Jumper Syndrome’.
        J. Trauma. 1986; 26: 706
        • Trunkey D.D.
        • Chapman M.W.
        • Lim R.C.
        • et al.
        Management of pelvic fractures in blunt trauma injury.
        J. Trauma. 1974; 14: 912
        • Yellin A.E.
        • Lundell C.J.
        • Finck E.J.
        Diagnosis and control of post traumatic pelvic hemorrhage.
        Arch. Surg. 1983; 118: 1378
        • Zannis V.J.
        • Wood M.
        Laparotomy for pelvic fracture.
        Am. J. Surg. 1980; 140: 841