Pelvic fracture combined with extraperitoneal bladder rupture and cervicovaginal separation in female: a case report and literature review

A female bladder rupture and the traumatic separation of the vagina from the uterus, combined with a pelvic fracture, is rather rare. The experience of how to handle this injury is still limited. Here, a middle-aged female patient with bladder rupture and nearly complete cervicovaginal separation associated with a traffic accident-induced pelvic fracture is described. The recommendations and management for this type of injury are discussed. A 46-year-old East Asian woman presented with a pelvic crush injury after a traffic accident. Imaging indicated pelvic fractures combined with extraperitoneal bladder rupture (EBI). A nearly complete cervicovaginal separation and parametrium hematoma with active bleeding were confirmed under exploratory laparotomy. Staged surgical management was conducted for this patient, and success was achieved in performing open reduction and internal fixation (ORIF), total hysterectomy, bilateral salpingo-oophorectomy, repair of the bladder rupture, and suprapubic cystostomy. Fracture healing and bladder continence were addressed uneventfully. Appropriate surgical management should be chosen for each patient, depending on their condition. Open pelvic fractures indicate a potentially fatal situation that requires immediate surgical intervention. Repairing bladder rupture as early as possible provides favorable bladder continence. For women with no demand for fertility, performing a total hysterectomy is feasible, especially when an experienced obstetrician–gynecologist is not readily available at the time.