The patient is awake and alert, and reports pain in his abdomen and pelvis. Examination also reveals abrasions on his abdominal wall surface and no signs or presence of blood on his external urethral meatus . Palpation reveals generalized tenderness over the entire abdominal region. In addition, the patient shows particular discomfort when you attempt to assess the stability of his pelvis by placing your hands over his pubic symphysis and laterally applying pressure over the iliac blades. He does not have full hip extension and rotation when you assess his mobility while laying on the exam table.
Rectal exam is negative for gross blood, and the patient has a normally placed prostate.
A diagnostic supraumbilical peritoneal lavage turns out negative. You suspect internal bleeding due to the abdominal pain, so you order an angiogram to locate the source. You diagnose a pelvic fracture, complicated by internal bleeding. The patient is taken to angiography where a laceration of the internal pudendal artery is found, and a selective embolization is performed. External fixation of the pelvis is performed after the bleeding has been stabilized.