Penetrating pelvic trauma: Initial assessment and surgical management in emergency.
E Hornez, T Monchal, G Boddaert, P Chiron, J Danis, Y Baudoin, J-L Daban, P Balandraud, S Bonnet
Author Information
E Hornez: Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France. Electronic address: emmanuelhornez@gmail.com.
T Monchal: Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Sainte-Anne, 83000 Toulon, France.
G Boddaert: Service de Chirurgie Thoracique et Vasculaire, Hôpital d'Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
P Chiron: Service d'Urologie, Hôpital d'Instruction des Armées Begin, 94160 Saint-Mandé, France.
J Danis: Service d'Orthopédie, Hôpital d'Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
Y Baudoin: Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
J-L Daban: Service d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
P Balandraud: Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Sainte-Anne, 83000 Toulon, France.
S Bonnet: Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
Penetrating pelvic trauma (PPT) is defined as a wound extending within the bony confines of the pelvis to involve the vascular, intestinal or urinary pelvic organs. The gravity of PPT is related to initial hemorrhage and the high risk of late infection. If the patient is hemodynamically unstable and in hemorrhagic shock, the urgent treatment goal is rapid achievement of hemostasis. Initial strategy relies on insertion of an intra-aortic occlusion balloon and/or extraperitoneal pelvic packing, performed while damage control resuscitation is ongoing before proceeding to arteriography. If hemodynamic instability persists, a laparotomy for hemostasis is performed without delay. In a hemodynamically stable patient, contrast-enhanced CT is systematically performed to obtain a comprehensive assessment of the lesions prior to surgery. At surgery, damage control principles should be applied to all involved systems (digestive, vascular, urinary and bone), with exteriorization of digestive and urinary channels, arterial revascularization, and wide drainage of peri-rectal and pelvic soft tissues. When immediate definitive surgery is performed, management must address the frequent associated lesions in order to reduce the risk of postoperative sepsis and fistula.
