MSSP586: NEW APPROACH IN MANAGING PELVIC GUNSHOT INJURIES
Yaser S Selim, MD, MRCS; Ministry of Health, Kingdom of Saudi Arabia
Introduction: Shotgun injuries are rare, with the extent of injury best determined at time of surgical exploration. There are no defined workup or management guidelines for patients with shotgun injuries to the genitourinary system. Injuries are usually treated on an individual basis.[i]
Case Report: We present a patient 26 years old having severe gunshot injury of the pelvis, with entry at the left gluteal region while the exit wound lies at the upper part of the right gluteal region we directly attacked internal iliac arteries as a first step with in continuity ligation, then when the bleeding from pelvic hematoma slowed down, we explored it for the source of continued bleeding we found a 1cm longitudinal tear of the internal iliac vein on the left side for which we ligated internal iliac vein
Discussion: Penetrating pelvic injury (PPI) is one of the most difficult to trauma surgeons, patients who have this condition have high-risk of visceral injury (rectum, bladder, distal ureters, internal genitalia, iliac vessels, sacral plexus and autonomic nerves). The risk of visceral injury from abdominal ballistic trauma occurs in up to 90% of cases.
Conclusion: We found that planned rapid ligation of both internal iliac arteries very helpful initial step for exploring pelvic hematoma with suspected vessel injury colostomy further add to vascular control
[i] Rabi tiguert et el. Management of shotgun injuries to the pelvis and lower genitourinary system Urology Volume 55, Issue 2, February 2000, Pages 193–197