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



• 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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