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Algorithm of Duncan et al for Managing a Patient with a Transpelvic Gunshot Wound

Purpose: To manage a patient with a transpelvic gunshot wound using the algorithm of Duncan et al.

Description

Duncan et al developed an algorithm to manage patients with transpelvic gunshot wounds. Although many patients with these wounds require surgical management, a significant percentage can be managed conservatively. The authors are from Kings County Hospital and the State University of New York in Brooklyn.


Potential injuries:

(1) vascular injury

(2) neurologic injury

(3) injuries to colon

(4) injuries to urinary bladder, ureter and/or urethra

(5) pelvic bone fracture

 

A patient is taken to the operating room if:

(1) clinically unstable

(2) digital rectal exam, proctoscopy and/or peritoneal lavage are positive for injury

(3) CT scan and/or contrast-enhanced CT enema is positive

(4) angiography is positive for vascular injury

(5) CT cystography  is positive

 

where:

• The patient may be a candidate for embolization by an interventional radiologist if only vascular injury is identified.

• The presence of a large amount of stool may make imaging studies and endoscopic examination difficult.

 

A patient who is stable and with negative studies can be observed.


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Specialty

Objective

ICD-10