Gunshot wounds to the pelvis and pelvic organs
Classification of gunshot wounds of the pelvis
Among the gunshot wounds of the pelvis are:
1) soft tissue injuries of the pelvic region,
2) soft tissues and pelvic bones,
3) the pelvis and pelvic organs (intraperitoneal and extraperitoneal).
With injuries of the soft tissues of the pelvis, damage to large blood vessels is possible, accompanied by dangerous internal or external bleeding. Damage to the sciatic nerve is manifested by paresis, paralysis and various types of sensory impairment. The proximity of the anus and the presence of large muscle masses in the wound area predispose to the development of severe wound infection, including anaerobic infection. Gunshot fractures of the pelvic bones without damage to internal organs. By the nature of the damage to the bone, fractures are distinguished by comminuted , perforated, marginal, tears and cracks. Localization – fractures of the ilium, pubic, sciatic bones, sacrum, sacroiliac joints, tailbone. Splinter fractured fractures predominate. Gunshot fractures are mainly classified as severe injuries, often complicated by massive bleeding and shock. When diagnosing pelvic gun fractures, the location of external wounds and subcutaneous hematomas, the projection of the wound canal and the localization of pain when pressing on the bone protrusions should be taken into account. Pubic bone fractures are characterized by pain that occurs at the fracture site when pressure is applied to the symphysis, sciatic bone fractures are recognized when pressure is applied to the ischial tubercles. In case of fractures of the anterior part of the pelvic ring , the symptom of a “stuck heel” is characteristic – it is impossible to raise a straightened leg. Coccyx fractures are better detected by rectal examination. X-ray examination of the wounded allows you to clarify the diagnosis. Gunshot wounds of the pelvis are often complicated by a wound infection: abscesses, phlegmon of the pelvic tissue, pelvic osteomyelitis, etc. acetabular fractures can be complicated by purulent coxitis, and wounds of the sacrum – by dysfunction of the pelvic organs and purulent meningitis. In some cases, after gunshot pelvic fractures, sepsis develops. Gunshot gas bone fractures with damage to internal organs. Injury is very severe. Bladder injuries are divided into extraperitoneal and intraperitoneal, isolated and combined with injury to other internal organs. When the wall of the bladder is covered with a peritoneum (intraperitoneal damage), urine enters the free abdominal cavity. Symptoms do not differ from those that occur with injuries of the hollow organs of the abdomen, especially since injuries of the bladder in most cases are combined with injuries of the intestine. Examination of the wounded reveals symptoms of peritoneal irritation and the presence of fluid in the abdominal cavity. The wounded cannot pee. When catheterizing with a soft catheter, a few drops of urine stained with blood are released. This confirms the diagnosis of a bladder injury. When the anterior wall of the extraperitoneal section of the bladder is wounded, urinary infiltration of the prebubble tissue occurs and urine infiltration spreads to both sides along the abdominal wall upward and parallel to the inguinal ligaments. Palpation is determined by pain and pastiness in the suprapubic and both inguinal areas. Urination is impaired. From the first days, the wounded fever. By timely surgical intervention, the progression of phlegmon and fiber necrosis can be prevented. When the lower parts of the bladder are injured near the neck, urinary infiltration extends to the perineum, scrotum root, and anus circumference. If the proximal urethra is injured, an enlarged bladder, bleeding from the urethra, and urinary perineal infiltration are determined. Rectal injuries are divided into intraperitoneal and extraperitoneal. Often they are observed in the wounded at the same time, and rectal wounds can be combined with damage to the bladder, urethra, pelvic fractures, and injuries of other parts of the intestine. They are complicated by shock. A reliable sign of rectal injury is the passage of feces through an external wound. Finger examination of the rectum (blood on the finger) is important for diagnosis. With intraperitoneal wounds, blood is rarely detected during a digital examination. Usually the wounded complain of pain in the rectum. With combinations of wounds of the bladder and rectum, desires to the bottom are frequent, while liquid feces with urine and an admixture of blood are allocated . It is also possible the secretion of feces and gases through the urethra. Intraperitoneal ruptures of the rectum are complicated by peritonitis. With extraperitoneal wounds, purulent or putrefactive processes develop in the pelvic tissue and muscles. Perhaps the development of anaerobic infections.
Femoral hernia is rare. More often it happens in older women and is due to the structural features of the pelvis and age-related tissue changes. It is formed above the inguinal ligament, exiting through the femoral canal more often inwards from the femoral vein, less often inwards from the vascular bundle and behind it. The contents of the hernial sac are intestinal loops, omentum, ovary, bladder (sliding hernia). Infringed more other hernias (55% of cases) in view of low density and ductility femoral canal walls (located behind the pubic bone and Cowper’s ligament front –inguinal ligament inside – zhimbfnatova ligament).
Femoral hernia clinic
Usually, due to the small size (2-3 cm in diameter) of the hernia, neither the doctor nor the patient pay attention to it. Only in case of infringement, when severe pain, vomiting and protrusion appear, are they diagnosed correctly. Infringement is often the first symptom of a hernia. A hernia is defined on the upper third of the thigh. It is necessary to differentiate a femoral hernia with lipoma, inguinal lymphadenitis, a leak in case of spinal tuberculosis, and tumor metastasis.