Your browser doesn't support javascript.
loading
Management of transpelvic gunshot wounds.
Duncan, A O; Phillips, T F; Scalea, T M; Maltz, S B; Atweh, N A; Sclafani, S J.
Afiliação
  • Duncan AO; Trauma Service, Kings County Hospital, Brooklyn, NY.
J Trauma ; 29(10): 1335-40, 1989 Oct.
Article em En | MEDLINE | ID: mdl-2810408
The records of 98 patients with transpelvic gunshot wounds from 1983 to 1988 were reviewed: 22 patients were admitted in shock and required aggressive resuscitation and immediate exploration, and 76 patients were normotensive and were evaluated with diagnostic peritoneal lavage, angiography, cystography, proctoscopy, CT scan, and contrast-enhanced CT enema in various combinations as indicated. Using this approach, 40 stable patients were observed without operation and discharged without complications. Fifty-eight patients were explored: 20 had both arterial and hollow viscus injuries. Thirty-nine major vascular injuries were evaluated: 27 were ligated and 12 repaired. Other injuries were colon, 27; including seven rectal perforations, multiple small bowel perforations, five bladder, one ovarian, four ureteral, three caval, three renal, and two distal aortic injuries. Colon injuries associated with vascular injuries were treated with colostomy and ligation of the vessel with extra-anatomic bypass when revascularization was required. Overall 12 patients died as a result of their injuries, a mortality of 12.2%. However, 50% of the patients who were admitted in shock died. Two external iliac artery injuries and two ureteral injuries were missed at initial operation. Penetrating trauma to the pelvis presents a serious challenge because of the complex anatomy of the region. Patients in shock have a high incidence of vascular injury and subsequent exsanguination, and associated visceral injuries may complicate their management. However, stable patients may be managed without operation, when appropriate diagnostic techniques fail to demonstrate an injury. Arterial ligation and extra-anatomic bypass should be considered for vascular injury with gross fecal contamination.
Assuntos
Buscar no Google
Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pelve / Ferimentos por Arma de Fogo Tipo de estudo: Diagnostic_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Trauma Ano de publicação: 1989 Tipo de documento: Article País de publicação: Estados Unidos
Buscar no Google
Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pelve / Ferimentos por Arma de Fogo Tipo de estudo: Diagnostic_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Trauma Ano de publicação: 1989 Tipo de documento: Article País de publicação: Estados Unidos