Herniation of the bladder after recurrent pubic symphysis diastasis

Bladder and urethral injuries are relatively common complications of pelvic trauma; however, bladder herniation into a pubic symphysis diastasis is an unusual sequelae of such trauma. The case reported here is that of a patient in whom the initial open-book type fracture of the pelvic ring with a major pubic diastasis was treated with external fixator. Ten weeks after satisfactory reduction, the fixator was removed. Four weeks later the symphysis reopened. Urinary discomfort with bladder herniation into the diastatic area developed. Direct surgical approach with internal fixation and fascial repair were necessary. At 6-year follow-up, the patient remains without symptom. The purpose of this report is to draw attention to a potentially higher risk of bladder herniation when closed reduction in traumatic pubic diastasis fails and to provide guidelines for evaluation and treatment of this uncommon complication.