Delayed Bladder Perforation Resulting From Large Bladder Stone and Gluteal Abscess Caused by Pelvic Plate Loosening: A Case Report

TL;DR

A woman developed bladder and gluteal complications 13 years after pelvic fracture surgery due to hardware loosening, highlighting the need for preventive surgical placement.

Contribution

Highlights a rare complication of pelvic hardware loosening and suggests a preventive surgical placement strategy.

Findings

Bladder perforation occurred due to migrated screws and a large bladder stone 13 years after pelvic fixation.

Gluteal abscess was linked to pelvic plate erosion into the bladder.

Proper hardware placement can reduce the risk of bladder perforation.

Abstract

Delayed bladder injuries resulting from screw or plate loosening, following pelvic ring fractures are rare, and this complication could be prevented. A 63-year-old woman presented with dysuria and lower abdominal pain, 13 years after the open fixation of a pelvic injury. Computed tomography revealed a 5-cm bladder stone and two migrated screws. Six months after the stone was removed, an abscess was noted over the left gluteal region. During the removal of the screw and abscess debridement, we accidentally observed that the anterior pelvic bridge plate had eroded into the bladder and had multiple bladder stones attached. After the involved hardware was removed, the abscess was debrided and the bladder was repaired. The patient did not have further urinary tract infections or urinary symptoms. In patients with pelvic ring fractures, we recommend placing the bridge plate on the superior side of the pubic symphysis to reduce the risk of bladder perforation in the event of plate or screw loosening. When a patient with a history of pelvic fixation presents with symptoms such as urinary tract infections, bladder stones, or even an abscess around the gluteal region, possible bladder perforation caused by the loosening of plates or screws should be considered.

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