Posterior urethral disruption secondary to a penetrating gluteal injury

Penetrating injury to the buttock: an update

Clinical research on penetrating injury to the buttock is sparse and largely limited to case reports and clinical series. The purpose of this paper is to provide a detailed overview of literature of the topic and to propose a basic algorithm for management of penetrating gluteal injuries (PGI). MEDLINE, EMBASE, Cochran, and CINAHL databases were employed. Thirty-seven papers were selected and retrieved for overview from 1,021 records. PGI accounts for 2-3 % of all penetrating injuries, with a mortality rate up to 4 %. Most haemodynamically stable patients will benefit from traditional wound care and selective non-operative management. When gluteal fascia injury is confirmed or suspected, a contrast-enhanced CT-scan provides the most accurate injury diagnosis. CT-scan-based angiography and endovascular interventions radically supplement assessment and management of patients with penetrating injury to the major buttock and adjacent extra-buttock arteries. Immediate life-saving damage-control surgery is indicated for patients with hypovolemic shock and signs of internal bleeding. A universal basic management algorithm is proposed. This overview shows that penetrating injury to the buttock should be regarded as a potential life-threatening injury, and therefore, patients with such injuries should be managed in trauma centres equipped with hybrid operating theatres for emergency endovascular and open surgery for multidisciplinary teams operating 24/7.

Analytical review of 664 cases of penetrating buttock trauma

A comprehensive review of data has not yet been provided as penetrating injury to the buttock is not a common condition accounting for 2-3% of all penetrating injuries. The aim of the study is to provide the as yet lacking analytical review of the literature on penetrating trauma to the buttock, with appraisal of characteristics, features, outcomes, and patterns of major injuries. Based on these results we will provide an algorithm. Using a set of terms we searched the databases Pub Med, EMBASE, Cochran, and CINAHL for articles published in English between 1970 and 2010. We analysed cumulative data from prospective and retrospective studies, and case reports. The literature search revealed 36 relevant articles containing data on 664 patients. There was no grade A evidence found. The injury population mostly consists of young males (95.4%) with a high proportion missile injury (75.9%). Bleeding was found to be the key problem which mostly occurs from internal injury and results in shock in 10%. Overall mortality is 2.9% with significant adverse impact of visceral or vascular injury and shock (P < 0.001). The major injury pattern significantly varies between shot and stab injury with small bowel, colon, or rectum injuries leading in shot wounds, whilst vascular injury leads in stab wounds (P < 0.01). Laparotomy was required in 26.9% of patients. Wound infection, sepsis or multiorgan failure, small bowel fistula, ileus, rebleeding, focal neurologic deficit, and urinary tract infection were the most common complications. Sharp differences in injury pattern endorse an algorithm for differential therapy of penetrating buttock trauma. In conclusion, penetrating buttock trauma should be regarded as a life-threatening injury with impact beyond the pelvis until proven otherwise.

Perforation of the ileum after a stab wound of the gluteal region: a case report

We present a case of a patient with a seemingly insignificant single gluteal stab wound which led to a solitary perforation of the ileum and delayed peritonitis. This case report illustrates that, despite the absence of any signs of bowel perforation on presentation, a patient may deteriorate gradually in the subsequent hours. This demonstrates the role of clinical observation in high risk gluteal stab wound patients.

Gluteal stab wound is a frequent and potentially dangerous injury

BACKGROUND

Stab wounds to the gluteal area are a frequent injury in an urban trauma centre. These injuries may appear innocuous but is potentially life threatening. Therefore they deserve timely evaluation and management. The purpose of this study was to evaluate our experience with this type of injury and to propose a treatment protocol.

METHODS

During the last 5 years 269 patients with stab injuries, were admitted to our Department of Emergency Medicine (DEM). Thirty-nine patients (14%) who had gluteal penetration were included in this study. Patients' charts were retrospectively reviewed for demographic data, type of injury and additional injuries, evaluation, management and outcome.

RESULTS

Stab wound of the gluteal region was the most frequent injury after chest and abdominal injuries. Thirty patients presented with soft tissue damage only and nine were severely injured. Seven of the severely injured patients had significant bleeding; two of them were treated by embolisation. One patient suffered a rectal injury and one a small bowel perforation, both treated surgically. There was no post-operative complication or mortality.

CONCLUSIONS

Penetration of the gluteal is a potentially life threatening injury. Meticulous observation and high level of suspicion ensure early treatment and can prevent mortality.