The World Society for Emergency Surgery (WSES) provides guidance for the management of a patient with pelvic trauma.
Patient selection: blunt or penetrating pelvic trauma
Indications for laparotomy:
(1) evisceration
(2) impalement
(3) peritonitis
(4) FAST-E positive
(5) perineal exam positive
(6) free air
(7) localized thickening of bowel wall on CT scan
(8) WSES Grade IV not controlled by initial preperitoneal pelvic packing and/or angioembolization
Indication for non-operative management:
(1) WSES I
Indications for proceeding directly to definitive mechanical stabilization - all of the following:
(1) hemodynamically stable
(2) mechanically unstable
(3) no other lesion requiring treatment
(4) negative CT scan
If the pelvis is mechanically unstable and if WSES Grades II to IV, then
(1) temporary mechanical stabilization may be performed.
(2) definitive mechanical stabilization may be performed once bleeding is under control and other lesions requiring treatment have been addressed
