Korean J Urol.  2011 Mar;52(3):221-224.

Vesico-Acetabular Fistula and Urolithiasis in the Hip Joint Cavity due to Persistent Bladder Entrapment after Acetabular Fracture

• Tolkach Y
• Gadjiev N
• Korol V
• Gonchar I

Abstract

We report a rare case of vesico-acetabular fistula due to an improperly treated pelvic fracture with urinary stone formation in the joint cavity. This complication was related to an unrecognized mechanism of bladder wall entrapment in the acetabular floor defect during weight bearing. This situation led to several mistreatment decisions in our case and should be always considered by urologists dealing with patients after major pelvic trauma. In this case report, we analyze the publications related to this problem, discuss the main mechanisms of bladder wall damage after acetabular fracture, and propose tips for diagnosis and treatment.

Keyword

Malunited fractures; Multiple trauma; Urinary bladder diseases; Urinary bladder fistula; Urinary calculi

MeSH Terms

Fistula
Floors and Floorcoverings
Fractures, Malunited
Hip
Hip Joint
Humans
Joints
Multiple Trauma
Urinary Bladder
Urinary Bladder Diseases
Urinary Bladder Fistula
Urinary Calculi
Urolithiasis
Weight-Bearing

Figure

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  FIG. 1 Computed tomography-tomogram showing bony fragment displacement and malunion after the left-side hip and pelvic fractures, which led to collapse of the femur head as the result of avascular necrosis and protrusion of the femur into the perforated acetabulum (central hip dislocation).

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  FIG. 2 Panoram X-Ray of pelvis (A) and miction cystourethrography (B). Arrow points to extravasation of the contrast medium.

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  FIG. 3 Non-enhanced computed tomography of the pelvis. Black arrow shows the left hip joint with free-lying dense objects within. The arrowhead points to the site of bladder wall impingement.

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  FIG. 4 Computed tomography-fistulography. Arrow shows contrast medium within the left hip joint (fistula tract) extending to the bladder lumen.

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  FIG. 5 Mechanism of bladder wall entrapment in central hip dislocation resulting from lateral load acetabular fracture: (A) Acetabular fracture (B) Dislocation, weight bearing in the fracture without fixation. (C) Reduction, release of the weight-bearing stress in the fracture left without fixation.

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