ABDOMINOPELVIGLUTEAL WAR WOUNDS - PRINCIP LES OF TREATMENT

From a series of 316 cases of war wounds, the authors selected those c ases in which the entry or exit wound was situated between the iliac c rests and the inferior gluteal fold and report a series of 21 wounds ( including 17 assault gunshot wounds) involving the perineal, pelvic an d/or gluteal regions. Wounds of these regions are characterized by the ir immediate severity (10% mortality in this series), due to the compl exity of combined lesions (urethra, rectum, hip, abdominal and vascula r lesions) and the severity of sequelae. This series included 5 anorec tal wounds, 5 urethral wounds and 4 hip wounds. Based on this series a nd a review of the literature, the authors discuss diagnostic problems (risk of missing abdominal penetration, a retroperitoneal rectal woun d or an articular wound). Principles of treatments are also described (wide debridement and drainage, systematic colostomy for wounds of the rectum and large soft tissues wounds, systematic cystostomy for bladd er and urethral wounds and alignment of urethral wounds whenever possi ble, articular lavage and immobilization by external fixation of hip w ounds).