Does the Intrapelvic Compartment Syndrome Exist?

Abstract

Pelvic compartment syndrome is a rare condition. As in other musculoskeletal localizations, the intra-compartmental pressure raises above a critical level. In the pelvic compartment syndromes, the gluteal compartments are mainly concerned. We report on three patients with bilateral ureteral obstruction, due to compression by a massive retroperitoneal haematoma as a complication of an unstable pelvic ring or acetabular fracture. Anuria with renal organ failure, due to compression of the ureters in the small true pelvis represents an intrapelvic compartment syndrome. Anuria, due to ureteral compression, mostly developing 24 to 48 hours after injury, has to be differentiated from anuria due to hypovolaemic shock or lesions of the lower urine tract.Bilateral tube nephrostomy represents a temporary and suboptimal therapy. Treatment of the intrapelvic compartment syndrome consists in fracture stabilization and surgical revision of the retroperitoneal space, including evacuation of the haematoma and decompression of the ureters, as it was performed in our patients. Persistent isolated bleeding points can be ligated. If the patient is haemodynamically stable, internal fracture fixation can be performed during the same operative session. A second look procedure may be required for prevention of septic complications.