%0 Journal Article
%T Penetrating Bladder Trauma: A High Risk Factor for Associated Rectal Injury
%A B. M. Pereira
%A L. O. Reis
%A T. R. Calderan
%A C. C. de Campos
%A G. P. Fraga
%J Advances in Urology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/386280
%X Demographics and mechanisms were analyzed in prospectively maintained level one trauma center database 1990¨C2012. Among 2,693 trauma laparotomies, 113 (4.1%) presented bladder lesions; 51.3% with penetrating injuries ( ); 41.3% ( ) with rectal injuries, males corresponding to 95.8%, mean age 29.8 years; 79.1% with gunshot wounds and 20.9% with impalement; 91.6% arriving the emergence room awake (Glasgow 14-15), hemodynamically stable (average systolic blood pressure 119.5£¿mmHg); 95.8% with macroscopic hematuria; and 100% with penetrating stigmata. Physical exam was not sensitive for rectal injuries, showing only 25% positivity in patients. While 60% of intraperitoneal bladder injuries were surgically repaired, extraperitoneal ones were mainly repaired using Foley catheter alone (87.6%). Rectal injuries, intraperitoneal in 66.6% of the cases and AAST-OIS grade II in 45.8%, were treated with primary suture plus protective colostomy; 8.3% were sigmoid injuries, and 70.8% of all injuries had a minimum stool spillage. Mean injury severity score was 19; mean length of stay 10 days; 20% of complications with no death. Concomitant rectal injuries were not a determinant prognosis factor. Penetrating bladder injuries are highly associated with rectal injuries (41.3%). Heme-negative rectal examination should not preclude proctoscopy and eventually rectal surgical exploration (only 25% sensitivity). 1. Introduction Penetrating trauma implies that either a gunshot wound or a stab wound has entered the abdominal cavity. The gunshot wound is associated with high-energy transfer and the extent of intra-abdominal injuries is difficult to predict. Both the path of the missile and secondary missiles are unpredictable, as well as bone fragments or fragments of the bullet that can inflict other injuries. The velocity of assault rifles and hunting firearms is much higher than that of civilian handguns and therefore has a much higher energy transfer to the tissue. Stab wound injuries can be inflicted by many objects other than knives, including knitting needles, garden forks, fence railing, wire, pencils, and pipes. They are usually more predictable with regard to injured organs. Nevertheless, a high index of suspicion must be maintained to avoid missing occult injuries [1]. Penetrating bladder injuries may be caused by injuries to the abdomen, thigh, or buttock just as rectal injuries. Any penetrating wound that may have injured the rectum should be fully evaluated to avoid severe complications [2]. This study aimed to report authors¡¯ experiences with associated
%U http://www.hindawi.com/journals/au/2014/386280/