UROLOGY JOURNAL   Vol. 11   No. 04   July - August 2014   1852

PICTORIAL

Urinary Bladder Herniation into Pubic Ramus Fracture

Mandeep Singh Ghuman,1  Shabdeep Kaur,2  Kavita Saggar1

A young adult male was admitted after suffering polytrauma due to road traffic accident. Emergency radiography showed pelvic fracture. Computed tomography (CT) scan was performed which revealed presence of comminuted displaced fracture of left superior pubic ramus. Fracture line was extending till pubic symphysis but no symphyseal diastasis was noted.  In addition, a part of urinary bladder was seen 
herniating in between the gaping bony margins of the fractured superior pubic ramus (Figures 1 and 2, arrows). In view of this unexpected CT scan 

finding, it was decided not to do external fixation and the patient was taken up for open reduction and internal fixation.

Although urological injuries are common in pelvic fractures, herniation or interposition of bladder into pelvic fractures is very rare phenomenon with 

available case reports mentioning herniation and subsequent entrapment into pubic symphyseal diastasis.(1-3) Interposition of the bladder into pubic 

rami fracture has not been reported before in the literature. Operative management is recommended in pelvic fractures with incorporated bladder.(1) 

High index of suspicion is required to detect any herniation of bladder, not only in cases of pubic diastasis but also in the presence of  rami fractures 

as overlooking this significant finding will lead to subsequent incarceration of urinary bladder following external fixation.(2,3) 

1Department of Radiodiagnosis, 
Dayanand Medical College and 
Hospital, Ludhiana-141001, In-
dia.
2Department of Radiodiagnosis, 
Indira Gandhi Medical College, 
Shimla-171001, India.

 
 

Corresponding Author:
Mandeep Singh Ghuman, MD
Department of Radiodiagnosis, 
Dayanand Medical College and 
Hospital, Ludhiana-141001, In-
dia.
E-mail: dr.msghuman@gmail-
com

Received October 2013
Accepted February 2014

REFERENCES
1.  Finnan RP, Herbenick MA, Prayson MJ, McCarthy MC. Bladder incarceration following anterior external fixation 
  of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation. Patient Saf 
  Surg. 2008;2:26.

2.  Bartlett CS, Ali A, Helfet DL. Bladder incarceration in a traumatic symphysis diastasis treated with external fixation: 
  a case report and review of the literature. J Orthop Trauma. 1998;12:64-7.

3.  Min W, Gaines RJ, Sagi HC. Delayed presentation of bladder entrapment secondary to nonoperative treatment of a 
  lateral compression pelvic fracture. J Orthop Trauma. 2010;24:e44-8.

Figure 1. Pelvic computed tomography scan, coronal sections, 
demonstrates herniation of urinary bladder (arrows) into the left 

superior pubic ramus fracture.

Figure 2. Pelvic computed tomography scan, axial and sagittal sec-
tions, shows herniation of urinary bladder (arrows) into the left supe-

rior pubic ramus fracture.