Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 12 , ISSUE 1 ( January-April, 2023 ) > List of Articles


Management of Transpelvic Gunshot Wounds in Civilian Trauma

Juan P Ramos, Analia Zinco, Jimy S Luna, Pablo Ottolino

Keywords : Damage control surgery, Gunshot wound, Pelvic Trauma, Penetrating trauma

Citation Information : Ramos JP, Zinco A, Luna JS, Ottolino P. Management of Transpelvic Gunshot Wounds in Civilian Trauma. Panam J Trauma Crit Care Emerg Surg 2023; 12 (1):20-24.

DOI: 10.5005/jp-journals-10030-1414

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Transpelvic gunshot wounds (TGWs) require special attention due to the high density of organs that can be injured within the pelvis, causing associated injuries and a high morbidity and mortality rate. The multiple systems that can be affected make their clinical evaluation difficult and require multiple diagnostic studies. This study aims to describe the demographic, diagnostic, and therapeutic characteristics of patients admitted with TGWs. Patients and methods: Retrospective, cross-sectional, and descriptive study, which included patients older than 15 years of age with a diagnosis of TGW admitted to two hospitals with a high rate of penetrating trauma in a period of 3 years. Results: The cohort was composed of 94 patients with TGWs. 68% of the population arrived with hypovolemic shock [shock index (SI) >0.7]. Trauma evolution time was <12 hours in 91%. Focused assessment with sonography for trauma (FAST) was negative in 91 cases (97%). Among the diagnostic studies, the following predominated: Tomography (65.2%), X-rays (11%), recto-sigmoidoscopy (5%), and urethrocystography (4%). A total of 56 therapeutic laparotomies (73.6%) and nine nontherapeutic (11.8%) were performed. The most frequently injured organs were—the small bowel (36%), colon (21.2%), rectum (13.8%), and bladder (13.8%). Damage control surgery (DCS) was performed in 25 patients (26.5%), and 28 (29.7%) required massive transfusion. The mean hospitalization was 6.7 days, the most frequent complications being surgical wound infection (8.5%), ileum (3.1%), anastomosis leak (2.1%), and wound hematoma (2.1%). Mortality was 8.2%. Conclusions: Transpelvic gunshot wounds (TGWs) must be managed differently from penetrating abdominal trauma. Most of these patients have multiple injuries requiring early surgical treatment, even when admitted stable. Its protocolization is necessary according to the resources of each center for an adequate initial diagnostic evaluation since the physical examination can be uncertain.

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