Rezaee Ahmad, Narouie Behzad, Haji-Rajabi Rahim, Ghasemi-Rad Mohammad, Shikhzadeh Abdolsamad
Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
J Med Case Rep. 2009 Nov 18;3:133. doi: 10.1186/1752-1947-3-133.
Urinary system fistula to the hip joint is a rare complication. We report a case of delayed posterior urethral fistula to the hip joint following penetrating gunshot wound injury.
A 37-year-old Iranian Balochi male was shot with a firearm in the superior part of his right pelvis. He underwent primary closure on the same day. Ten months later, he developed urinary retention. He underwent retrograde urethrography and antegrade cystography which showed a stricture measuring 5 cm in length. There was also a history of progressive pain in the right hip joint accompanied by low grade fever which started 2 months after the initial injury. Hip X-ray showed evidence of an acetabular cavity and femoral head destruction diagnostic of complicated septic arthritis. The patient subsequently underwent reconstructive surgery for the urethral stricture and urethral fistula via a transperineal approach followed by total hip arthroplasty.
Hip joint contamination with urine following a urethro-acetabular fistula can lead to severe and disabling complications such as septic arthritis. We recommend that every clinician should keep these fistulas in mind as a complication of penetrating urethral injury and every attempt should be made for their early diagnosis and prompt treatment.
泌尿系统与髋关节形成瘘管是一种罕见的并发症。我们报告一例穿透性枪伤后迟发性后尿道-髋关节瘘的病例。
一名37岁的伊朗俾路支男性，右骨盆上部遭枪击。当天他接受了一期缝合。十个月后，他出现尿潴留。他接受了逆行尿道造影和顺行膀胱造影，结果显示有一处5厘米长的狭窄。最初受伤两个月后，他还出现了右髋关节进行性疼痛并伴有低热的情况。髋关节X线检查显示有髋臼腔和股骨头破坏，诊断为复杂性化脓性关节炎。该患者随后经会阴入路接受了尿道狭窄和尿道瘘的重建手术，随后进行了全髋关节置换术。
尿道-髋臼瘘导致尿液污染髋关节可引发严重且致残的并发症，如化脓性关节炎。我们建议每位临床医生都应将这些瘘管视为穿透性尿道损伤的并发症并予以重视，应尽一切努力对其进行早期诊断和及时治疗。
