Vulvar and perineal injury secondary to complex pelvic and perineal trauma: case presentation and review of the literature
DOI:
https://doi.org/10.18597/rcog.295Keywords:
Wounds, trauma, vulva, genitalia, female, injuries, gynecologyAbstract
Objective: To review the literature focused on the description of the surgical anatomy, diagnosis and management of vulvar and perineal injuries secondary to high-impact genital and perineal trauma.
Materials and methods: Case presentation of a 15-year old adolescent who sustained unstable pelvic fracture, rectal tear and vulvar trauma with destruction of the pelvic floor anatomy, seen at a clinic located in Bogota (Colombia). The pelvic floor was reconstructed immediately by the gynaecology service and the other injuries were managed jointly with the general and orthopaedic surgeons. A review of the published literature between 1940 and 2015 was conducted in the Medline database via Pubmed using the following MeSH terms: wounds and trauma, vulva, genitalia, female, injuries and gynaecology. Moreover, a search was conducted in EBSCO and LILACS of review articles and case reports published in English and Spanish.
Results: Initially, 20 articles were selected but 6 that focused on the management of obstetric trauma, prolapse-related trauma or major trauma with abdominal compromise were discarded. A total of 14 articles were included. Of the total number of cases, 3 are described in pre-pubertal patients, 9 in women in childbearing age, and 2 in postmenopausal women, with different mechanisms of injury. The diagnosis is based on the clinical record and the physical exam. Diagnostic imaging could help determine the severity of the pelvic damage. This condition is considered a surgical emergency requiring the repair of muscles and nerves, and ligation of bleeding vessels. Moreover, the need for intestinal and urinary shunt has to be determined.
Conclusion: Vulvar trauma is a surgical emergency because of the consequences for the functionality of the genitourinary tract and the risk of contamination or tissue loss. Intervention must be timely, with a multidisciplinary approach to management. The surgical approach depends on the findings at the time of assessment and on the associated medical conditions.
Author Biographies
María Camila Hernández-Tiria
Antonio José Navarro-Devia
Ana María Osorio-Ruiz
References
Jana N, Santra D, Das D, Das AK, Dasgupta S. Nonobstetric lower genital tract injuries in rural India. Int J Gynaecol Obstet. 2008;103:26-9.
Merritt DF. Genital trauma in the pediatric and adolescent female. Obstet Gynecol Clin North Am. 2009;36:85-98.
Hollenbeck ST, Toranto JD, Taylor BJ, Ho TQ, Zenn MR, Erdmann D, et al. Perineal and lower extremity reconstruction. Plast Reconstr Surg. 2011;128: 551e-563e.
Arvieux C, Thony F, Broux C, Ageron F, Rancurel E, Abba J, et al. Current management of severe pelvic and perineal trauma. J Visc Surg. 2012;149:e227-38.
Hertweck P, Yoost J. Pediatric and Adolescent Gynecology: Common Problems. Expert Review of Obstetrics & Gynecology. 2010;5:311-28.
Stefanski L, Lampe P, Aleksandrowicz R. The probability of finding nerve branches to the external anal sphincter. Surg Radiol Anat. 2008;30:675-8.
Collinge C, Tornetta P 3rd. Soft tissue injuries associated with pelvic fractures. Othop Clin North Am. 2004;35:451-6.
McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am. 2013; 40:323-34.
Shewakramani S, Reed KC. Genitourinary Trauma. Emerg Med Clin North Am. 2011;29:501-18.
Hosseinzadeh K, Heller MT, Houshmand G. Imaging of the female perineum in adults. Radiographics. 2012;32:E129-68.
Lammers K, Fütterer JJ, Prokop M, Vierhout ME, Kluivers KB. Diagnosing pubovisceral avulsions: a systematic review of the clinical relevance of a prevalent anatomical defect. Int Urogynecol J. 2012;23:1653-64.
Hashish A. Perineal trauma in children: a standardized management approach. Annals of Pediatric Surgery. 2011;5:55-60.
Mercado J, Brea I, Mendez B, Quinones H, Rodriguez D. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013;31:207-36.
Djakovic N, Plas E, Martínez-Piñeiro L, Lynch TH, Mor Y, Santucci RA, et al. Guidelines on urological trauma. Arnhem: European Association of Urology (EAU); 2009. p. 69-76.
Furtmüller GJ, McKenna CA, Ebmer J, Dellon AL. Pudendal ner ve 3-dimensional illustration gives insight into surgical approaches. Ann Plast Surg. 2014;73:670-8.
Carrillo K, Sanguineti A. Anatomía del piso pélvico. Rev Med Clin Condes. 2013; 24:185-9.
How to Cite
Downloads
Downloads
Published
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
