A 45 year old with trauma presents after 4 hours with cheek swelling and urine not passed. On examination cerpitus is palpated with periorbital swelling. What is your diagnosis?
**Core Concept**
The patient's presentation of cheek swelling, periorbital swelling, and inability to pass urine following trauma suggests a retroperitoneal hematoma causing urethral compression and urinary retention. This is a classic example of a complication of pelvic fracture, specifically a urethral injury.
**Why the Correct Answer is Right**
The mechanism of injury in this case is likely a pelvic fracture, which can result in a urethral injury. The urethra is compressed by the expanding hematoma, leading to urinary retention. The presence of cerpitus (pain on palpation of the suprapubic area) and periorbital swelling suggests a retroperitoneal hematoma. The urethral injury is a result of the shearing forces generated by the pelvic fracture, which can cause disruption of the urethral lumen.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not account for the patient's inability to pass urine and the presence of periorbital swelling. A simple fracture would not typically cause these symptoms.
**Option B:** This option is incorrect because it does not address the urethral injury or the retroperitoneal hematoma. A bladder injury would not typically cause periorbital swelling.
**Option C:** This option is incorrect because it does not account for the patient's inability to pass urine and the presence of cerpitus. A ureteral injury would not typically cause these symptoms.
**Option D:** This option is incorrect because it is too nonspecific and does not account for the patient's specific symptoms and presentation.
**Clinical Pearl / High-Yield Fact**
In cases of pelvic trauma, always consider a urethral injury in the presence of urinary retention, periorbital swelling, and cerpitus. A high index of suspicion is necessary to avoid missing this diagnosis.
**Correct Answer:** C.