Article Figures & Data
- Figure 1
Temporal distribution of penetrating gluteal injuries.
- Figure 2
Temporal distribution of penetrating gluteal injuries in under 18s (U18).
- Figure 3
Anatomic distribution of penetrating gluteal injuries (PGI).
- Figure 4
St Mary’s pathway for penetrating gluteal injuries. Pt; patient, D/W; discuss with, ED; emergency department, CT; computed tomography, PV; portal venous,EUA; examination under anesthetic, GA; general anaesthetic, Gen Surg; general surgery, IR; interventional radiology, Redthread; local violence reduction charity, RS; rigid sigmoidoscopy, TTL; trauma team leader; Vasc; vascular surgery.
- Table 1
Chronological distribution of PGI and percentage of total penetrating injuries
Year Total penetrating trauma PGI Percentage of PGI 2017 640 47 7 2018 634 48 7 2019 559 30 5 2017–2019 1833 125 7 PGI, penetrating gluteal injury.
- Table 2
Comparison with 3 years preceding this study
2014–2016 2017–2019 % increase Total penetrating 1272 1831 43 Total PGI 67 125 87 % PGI 5 7 PGI, penetrating gluteal injury.
- Table 3
Absolute risk (AR) of significant structure injury by quadrant of injury
Quadrant AR (%) Upper outer 20 Upper inner 14 Lower outer 17 Lower inner 56 Overall per wound 24 Overall per patient 27 - Table 4
Clinical examinations performed in the emergency department
Examination n (%) Digital rectal examination 13 (10) Rigid sigmoidoscopy 11 (9) Nil 98 (78) Refused 3 (2) - Table 5
Choice of imaging for penetrating gluteal injuries
Type of CT scan n Sensitivity (%) Specificity (%) Single-phase combi scan 57 50 95 Dual-phase/triple-phase scan 56 50 90 No CT scan 14 – – - Table 6
Vascular injuries
Quadrant of injury Major bleeding Vessel injured Management Not recorded Yes Branch of the right inferior gluteal artery. Embolization. LI Yes Arterial bleeding within the left bulbocavernosus muscle, arterial bleeding within the left obturator externus muscle, extending into the left prostate peripheral/central zone.
Arterial/venous bleeding into the rectal lumen.Conservative. LI Yes Right internal pudendal artery. Conservative. Not recorded No Intramuscular branch (gluteal). Conservative. UO No Intramuscular branch (gluteal). Conservative. UO No Branch of the right superior gluteal artery. Embolization. LO+LI No Active venous and arterial bleeding from the small branches of the left deep artery and vein of the thigh. Embolization. LI No Bleeding from profunda femoris+arteriovenous fistula. Embolization+endovascular repair of arteriovenous fistula. LO No Intramuscular branch (gluteal). Conservative. UI+LO No Small branch of profunda femoris. Conservative. LO No Branch of the left superior gluteal artery. Conservative. UO+LI No Intramuscular branch (gluteal). Conservative. UO No Perforating gluteal artery. Conservative. LI, lower inner; LO, lower outer; UI, upper inner; UO, upper outer.
- Table 7
Rectal injuries
Quadrant Injury Management LI Extraperitoneal, anterior+posterior rectal injury, >25% circumference. Diagnostic laparoscopy+defunctioning ileostomy. Reversed 5 months later. LI Extraperitoneal injury at 5 o’clock position, <25% circumference, some division of sphincter. Rectum sutured+drain inserted. Diagnostic laparoscopy normal. LI Suspected extraperitoneal rectal injury <25% circumference.
Intramural blood, blood, and feces obscuring view on RS, large mesorectal hematoma on diagnostic laparoscopy.Laparoscopic loop colostomy, reversed 3 months later. LI Anal sphincter injury, <25% circumference. Washout+packing. UI Extraperitoneal injury, 25% of circumference, 6–9 o’clock 8 cm from anal verge. Laparoscopic loop colostomy. Reversed 6 months later. LI Extraperitoneal, laceration 2 cm from anal verge extending radially to around 4 cm, <25% circumference. External anal sphincter fibers seen. EUA+packing of rectum+RS+second look EUA. EUA, examination under anesthetic; LI, lower inner; RS, rigid sigmoidoscopy; UI, upper inner.
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Supplementary Data
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