A 24-year-old man is involved in an industrial accident in which he sustains a crushed pelvis. Diagnostic peritoneal lavage is positive. At exploration, a large pelvic hematoma is found. What is the best treatment?

C. Do not explore the pelvic hematoma. Apply a pelvic fixator and send the patient to radiology for possible embolization of bleeding pelvic vessels.

DISCUSSION: Pelvic hematomas are not usually the result of common or external iliac artery disruption. Therefore, unless the hematoma is rapidly expanding in the area of one of the major iliac arteries, it is not opened. Instead, the pelvic fracture is fixed externally and arteriography is performed. Usually, bleeding is from smaller arteries as they exit through the fracture site. These are best controlled with embolization. The other options are poor surgical choices that have little chance of success.