After a fall, a patient exhibits extensive perineal ecchymosis. What should be the next step in management?

In cases where a patient presents with extensive perineal ecchymosis following a fall, it is crucial to consider the possibility of pelvic fractures and associated injuries, particularly to the urinary tract. Extensive perineal bruising can indicate trauma to the urogenital region, and urinary tract imaging is a critical step in assessing for injuries such as bladder rupture or urethral injuries.

Urinary tract imaging, typically through a retrograde urethrogram or CT scan with contrast of the pelvis, allows for a thorough evaluation of the urinary system and helps identify any potentially life-threatening injuries that may need surgical intervention. It is vital to perform this imaging early in the management to prevent complications from undiagnosed injuries.

While a CT scan of the abdomen may provide valuable information regarding other potential injuries within the abdominal cavity, it does not specifically focus on the urinary tract. An extensive physical examination is always important; however, it may not detect internal injuries adequately. Immediate surgery is reserved for clear indications of life-threatening hemorrhage or injury that necessitate immediate intervention, rather than for diagnosing a potential injury.

Thus, the next step in management after observing extensive perineal ecchymosis is to conduct urinary tract imaging to assess for any urinary injuries resulting from the