[Penetrating gluteal injuries management--the need for management protocols]

Gunshot wounds are the most common cause of penetrating injuries in the gluteal region (PIGR), while only 17.5% result from stabbing. Complications and even death have been described as resulting from stab injury in this area, which is thus a hazard that demands an algorithm for proper management. Recently, DiGiacomo et al. recommended that transpelvic bullet trajectory warrants surgery. Mercer et al., in a study of 81 patients with PIGR, recommended an algorithm based on anatomical gluteal zones and concluded that angiography is not mandatory in such injuries. We describe 9 cases of PIGR, 4 of which were from stab wound and 1 a gunshot wound, which bled from rami of the gluteal arteries. In 2 there was no apparent bleeding, and they were hemodynamically stable. Thus in this type of injury significant damage may be obscured. Our results suggest that angiography is important in the evaluation of such injuries an should be part of the protocol for management of PIGR.