Alasdair K. T. Conn PenetratingTraumato, the Flank
Pathophysiology ClinicaLFeatures Diagnosis Treatment
Penetrating injuries to the flank and buttock challenge the physician because of the possibility of missed injuries to retroperitoneal structures. Gunshot and stab wounds in these areas must be carefully evaluated to determine whether there is retroperitoneal injury with intraperitoneal or vascular injury that might mandate immediate surgical intervention. Evaluation is difficult; the retroperitoneal structures are well protected by dense layers of musculature and the spine. There is significant risk of missed injury and delay in diagnosis. Fortunately, an increased armamentarium of diagnostic testing assists in timely diagnosis and allows for selective conservative management. The choice of management, conservative or operative, is determined based upon the emergency evaluation, making the emergency physician's input essential to a correct decision and a clinically successful outcome. Penetrating injuries to the buttock are relatively uncommon and some trauma centers report as few as three to five patients with this type of injury per year. Trauma centers in urban settings have reported 50 to 80 patients per year. With appropriate management the mortality is low, but case reports indicate that there is a potential for a missed injury to the bowel or major vessels, especially with shotgun or high velocity gunshot wounds, unless the clinician is vigilant in the emergency evaluation. This chapter outlines the evaluation of patients who present to the Emergency Department (ED) with penetrating trauma to the flank and to the buttock.
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