GUNSHOT WOUNDS TO THE BUTTOCKS - PREDICTING THE NEED FOR OPERATION

BACKGROUND: Gunshot wounds to the buttocks may cause significant intra -abdominal injuries. Policies of aggres sive abdominal exploration or extensive diagnostic testing have been suggested to avoid delays in tr eatment and consequent morbidity. Our group has recently suggested tha t clinical examination is a safe and reliable tool for triaging patien ts with anterior and posterior abdominal gunshot wounds. OBJECTIVE: Th is study was undertaken to test the hypothesis that patients with guns hot wounds to the buttocks can be managed selectively on the basis of clinical findings. SETTING: A large academic Level I trauma center was the setting for this study. PATIENTS AND METHODS: Fifty-nine consecut ive patients, suffering from gunshot wounds to the buttocks with poten tial retroperitoneal trajectories, were managed during a 12-month peri od in our center. RESULTS: Based on clinical findings, 19 (32.2 percen t) patients were operated on, with significant intraabdominal injuries in 17 (28.8 percent). The remaining 40 (67.8 percent) patients were s uccessfully observed. There were no missed injuries or delays in diagn osis. Sensitivity and specificity of clinical examination for identify ing significant intra-abdominal injury was 100 percent and 95.3 percen t, respectively. CONCLUSION: Clinical examination is a safe method for selecting patients with gunshot wounds to the buttocks for nonoperati ve treatment.