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[Perineal injuries in complicated pelvic trauma]
A David1, G Mollenhoff, C Josten
1Berufsgenossenschaftliche Kliniken Bergmannsheil, Chirurgische Klinik und Poliklinik, Bochum.
Swiss Surgery = Schweizer Chirurgie = Chirurgie Suisse = Chirurgia Svizzera
|January 1, 1996
Summary
Severe pelvic fractures often cause genitourinary and rectal injuries. Prompt management of shock, pelvic stabilization, and surgical repair of rectal injuries are crucial for patient outcomes.
Area of Science:
- Trauma surgery
- Emergency medicine
- Orthopedic surgery
Context:
- Severe comminuted pelvic ring fractures frequently involve genitourinary and rectal structures.
- Retroperitoneal bleeding and hypovolemic shock necessitate immediate management.
- Perineal injuries require thorough diagnostic evaluation after initial resuscitation.
Purpose:
- To outline the emergency management protocol for severe comminuted pelvic ring fractures with associated injuries.
- To detail diagnostic modalities for genitourinary and rectal trauma.
- To describe initial treatment strategies for pelvic, bladder, urethral, and rectal injuries.
Summary:
- Initial management focuses on hemodynamic stabilization, including volume resuscitation and pelvic clamp application if needed.
- Diagnostic workup involves endoscopy, endosonography, ultrasound, and contrast imaging to assess rectal and genitourinary injuries.
- Surgical interventions include debridement, lavage, drainage for rectal wounds, primary suture repair of rectal lacerations, and deviation colostomy for colonic/rectal injuries.
Impact:
- Establishes a critical care pathway for complex pelvic fractures.
- Emphasizes timely surgical intervention for rectal injuries to improve functional outcomes.
- Highlights the importance of a multidisciplinary approach in managing life-threatening pelvic trauma.