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A systematic review of penetrating perineal trauma in a civilian setting

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Penetrating injuries to the perineum and associated pelvic organs have largely been reported in the military. Given the rarity of presentation and unique clinical characteristics of these injuries, we set out to address the gap in the literature in civilian settings.

Methods

A systematic review of studies addressing penetrating perineal trauma from January 2000 to April 2021 was performed. Outcomes of interest were the epidemiology, associated injuries, management, follow-up, and patient outcomes.

Results

26 studies were included in this review, reporting on a total of 2316 patients. Most injuries occurred in males (88.1%), with gunshot wounds (88.2%) representing the most common aetiology, followed by knife wounds (5.0%), impalement (3.1%), coital injuries/sexual assault (1.5%), and others (2.4%). Regarding associated injuries, anorectal (n = 1419, 69.4%), bladder (n = 351, 32.4%), penile (n = 282, 20.8%), scrotal (n = 375, 27.7%), and testicular (n = 229, 16.9%) occurred frequently. Bony injuries involved the pelvis (n = 88, 8.1%) and femoral fractures (n = 5, 0.5%), while soft-tissue injuries involved the inguinal region (n = 19, 1.6%) and buttocks (n = 14, 1.3%). Vascular injuries occurred in 79 (7.8%) patients. Regarding patient outcomes, 65 (4.8%) deaths were reported, and significant morbidity was detected with a mean injury severity score of 18.4 detected in the cohort. In terms of complications of injury, wound/infective complications (n = 135, 61.3%) and fistula formation/leakage (n = 16, 0.7%) featured prominently.

Conclusion

Penetrating perineal trauma in the civilian population poses a considerable challenge to clinicians, compounded by the potential for multisystem injury requiring involvement of different medical and surgical specialties.

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Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore

    Elliot Yeung Chong, Daniel Wen Xiang Goh & Angela Hui-Shan Lim

  2. Department of General Surgery, Tan Tock Seng Hospital, Singapore city, Singapore

    Serene Si Ning Goh & Sunder Balasubramaniam

Authors
  1. Elliot Yeung Chong
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  2. Daniel Wen Xiang Goh
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  3. Angela Hui-Shan Lim
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  4. Serene Si Ning Goh
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  5. Sunder Balasubramaniam
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Contributions

All authors contributed to the study conception and design. Literature search, data collection, and analysis were performed by EYC, DWXG, and AH-SL. The first draft of the manuscript was written by EYC, DWXG, and AH-SL, and all authors commented on previous versions of the manuscript. SSNG and SB contributed to the development of research objectives and inclusion criteria, contributed to the elaboration of keywords, validated the search strategy and the data extraction form, and critically revised and approved the final version of the manuscript. All authors read and approved the final manuscript. EYC, DWXG, and AH-SL are considered to have contributed equally to the project and are considered to be joint first-authors.

Corresponding author

Correspondence to Sunder Balasubramaniam.

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Conflict of interests

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

This is a systemic review. No ethical approval was required given the nature of the nature of this study.

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Chong, E.Y., Goh, D.W.X., Lim, A.HS. et al. A systematic review of penetrating perineal trauma in a civilian setting. Eur J Trauma Emerg Surg 48, 4365–4383 (2022). https://doi.org/10.1007/s00068-022-01908-z

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  • DOI: https://doi.org/10.1007/s00068-022-01908-z

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