Penetrating injury to the buttock: an update

Abstract

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.

Buttock wounds: beware what lies beneath

“…Those relevant to our case are first, external bleeding from a wound initially treated conservatively with a deeper injury difficult to assess surgically and second, a pseudoaneurysm 16. In our case, given the presence of a small pseudoaneurysm on initial CT imaging, a digital subtraction angiogram may have allowed embolisation of the pseudoaneurysm.…”

“…One recent review synthesised the sparse evidence to devise a management algorithm for penetrating gluteal injuries 16. It is suggested that patients in hypovolaemic shock should progress directly to surgery.…”

Penetrating Sharp Object Injury in the Gluteal Region and Small Bowel Perforation Due to Pelvic Penetration: A Case Report

“…Surgery, angioembolization or observation could be preferred according to the observed bleeding and abdominal injuries. 2 In 2014, Lunevicius et al, 8 updated the algorithm and recommended evaluation in the following order: general inspection of the patient, controlling the femoral pulse, neurological examination of the lower extremities, examination of urethra and rectum, and then rectoscopy was suggested after the patient became stable. 9 Radiologists recommend contrast-enhanced rectal CT if there is still clinical suspicion of rectal injury despite rectoscopy.…”

Ileum Perforation after a Single Gluteal Stab Wound

“…There is no generally accepted method for evaluating gluteal region penetrating injuries. However, a new algorithm was introduced by Lunevicius et al (6) Control of the femoral pulse and the external urethral meatus, neurological examination of the lower extremities, and examination of the rectum should definitely be performed after general inspection according to this algorithm. If there are shock findings in the patient, damage control surgery or definitive surgery should quickly be performed.…”

“…If the patient is stable, examination should be continued. In the case of clinical suspicion, rectoscopy/rectosigmoidoscopy should be planned (6). If the bleeding through the skin cannot be brought under control by tamponade, arteriography (Doppler ultrasonography, CT angiography, or invasive angiography) should be planned (7).…”