A young man gets into a fight after taking beer and is kicked by the lower abdomen. There was pelvic fracture. Blood at meatus. Most likely cause is ?
**Core Concept**
The patient's presentation of pelvic fracture, blood at the meatus, and recent trauma suggests a high-riding prostate with possible urethral injury, which can lead to a condition known as urethral rupture or urethral stricture.
**Why the Correct Answer is Right**
The patient's symptoms are likely due to a traumatic urethral injury, which can occur when the urethra is stretched or severed during a pelvic fracture. This can lead to blood at the meatus, which is the opening of the urethra at the tip of the penis. The high-riding prostate, which is a common finding in men with urethral injuries, can also cause difficulty in passing urine.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option may be a distractor, but the patient's symptoms are not consistent with a testicular injury, which would typically present with pain and swelling in the scrotum.
* **Option B:** While a pelvic fracture can cause blood in the urine, it is not the most likely cause of blood at the meatus.
* **Option C:** This option may be a distractor, but the patient's symptoms are not consistent with a rectal injury, which would typically present with bleeding and pain in the rectal area.
**Clinical Pearl / High-Yield Fact**
In cases of suspected urethral injury, it is essential to perform a digital rectal exam (DRE) to assess the prostate and urethra, and to perform a retrograde urethrogram (RUG) to visualize the urethra and diagnose any injuries.
**Correct Answer:** D.