THE ROLE OF SIGMOIDOSCOPY IN THE MANAGEMENT OF GUNSHOT WOUNDS TO THE BUTTOCKS

The charts of all patients (n = 70) admitted over 26 months after sust aining a gunshot wound to the buttocks were reviewed to assess the rol e of physical examination, routine radiologic studies, and sigmoidosco py in the evaluation of these patients. There were 68 men and 2 women. Sixteen patients underwent sigmoidoscopy, which demonstrated a rectal injury in 7. Six of these patients had other abnormalities on either physical examination or plain pelvic radiographs that would have other wise led to operation. There were no missed injuries and no morbidity in the remaining patients that were managed without sigmoidoscopy. Ind ications for sigmoidoscopy were gross blood on rectal examination in 2 , bullet path with proximity to the rectum in 13, and persistent abdom inal pain in 1. All patients with gross blood on rectal examination (n = 5) and blood at the urethral meatus (n = 2) had visceral injuries. One patient underwent celiotomy for an injury at 15 cm that was noted on sigmoidoscopy performed because the bullet trajectory was in proxim ity to the rectum. Sigmoidoscopy can be performed selectively in patie nts sustaining a gunshot wound to the buttocks when the proximity of t he wound to the rectum is in doubt.