Gunshot wounds to the buttocks: Predicting the need for operation

BACKGROUND: Gunshot wounds to the buttocks may cause significant intra- abdominal injuries. Policies of aggressive abdominal exploration or extensive diagnostic testing have been suggested to avoid delays in treatment and consequent morbidity. Our group has recently suggested that clinical examination is a safe and reliable tool for triaging patients with anterior and posterior abdominal gunshot wounds. OBJECTIVE: This study was undertaken to test the hypothesis that patients with gunshot wounds to the buttocks can be managed selectively on the basis of clinical findings. SETTING: A large academic Level I trauma center was the setting for this study. PATIENTS AND METHODS: Fifty-nine consecutive patients, suffering from gunshot wounds to the buttocks with potential retroperitoneal trajectories, were managed during a 12-month period in our center. RESULTS: Based on clinical findings, 19 (32.2 percent) patients were operated on, with significant intraabdominal injuries in 17 (28.8 percent). The remaining 40 (67.8 percent) patients were successfully observed. There were no missed injuries or delays in diagnosis. Sensitivity and specificity of clinical examination for identifying significant intra-abdominal injury was 100 percent and 95.3 percent, respectively. CONCLUSION: Clinical examination is a safe method for selecting patients with gunshot wounds to the buttocks for nonoperative treatment.