Penetrierende Gluteale Pfählungsverletzung durch Schlittenunfall

Zusammenfassung

Wir stellen den seltenen Fall einer glutealen Perforation durch einen Schlittenunfall vor. Einem im Sitzen rodelnden 39-jähriger Mann zerbricht der Schlitten bei einem Sprung in eine Mulde; dabei bohrt sich ein Anteil der Sitzlatte in den Gluteus, und perforiert von der inferioren Glutealfalte bis in Höhe des lumbosakralen Übergangs. Rektum und Schließmuskel sind unverletzt, obwohl die Perforation den Muskel tangential freigelegt hat. Eine Blutung trat nicht auf. Der Patient wird kontinent und ohne Infektzeichen am 4. postoperativen Tag entlassen. Schlittenverletzungen sind in der Regel stumpfe Verletzungen, die mit Neurotrauma und/oder Frakturen und Luxationen einhergehen. Vorgehensweisen bei penetrierenden Glutealverletzungen werden diskutiert.

Abstract

We present the case of a rare penetrating sledging injury. A 39-year-old male sitting upright had his sledge burst when sliding into a pit. A stick fractured from the sledge’s sitting plate and perforated from the infragluteal fold up to the lumbosacral junction. The man arrived in a conscious and cardiovascular stable condition in the ER, where no clinical evidence of vascular, retroperitoneal and pelvic injury was obvious. The anal external sphincter was uninjured and competent although the perforation enabled a look onto its surface. The foreign body was removed without further bleeding. Sledging injuries typically carry blunt characteristics, mainly with neurotrauma or fracture dislocations. As penetrating sledging injuries are exceptionally rare, strategies are discussed.

Schlüsselwörter

Schlittenunfall - gluteale Perforation - gluteale Pfählungsverletzung - penetrierende Glutealverletzung

Key words

sledging/tobogganing accident - gluteal perforation - gluteal impalement - penetrating gluteal injury

• Literatur

• 1 US Consumer Product Safety Commission. NEISS Data Highlights 2007: Tobboggans, Sleds, Snow Discs, etc. Ausdruck aus http://www.cpsc.gov/Neiss/2007highlights.pdf
• 2 Juang D, Feliz A, Miller KA et al. Sledding injuries: a rationale for helmet usage. J Trauma 2010; 69 (Suppl. 04) S206-S208
• 3 Regan LA, Cooper JG. Sledging is still a seasonal source of serious injury in Scottish children. Scott Med J 2011; 56 (04) 188-190
• 4 Gilroy D, Saadia R, Hide G et al. Penetrating injury to the gluteal region. J Trauma 1992; 32 (03) 294-297
• 5 Ivatury RR, Rao PM, Nallathambi M et al. Penetrating gluteal injuries. J Trauma 1982; 22 (08) 706-709
• 6 Velmahos GC, Demetriades D, Cornwell EE et al. Gunshot wounds to the buttocks: predicting the need for operation. Dis Colon Rectum 1997; 40 (03) 307-311
• 7 Doll D, Lenz S, Exadaktylos AK et al. Penetrating injuries to the pelvis. Chirurg 2006; 77 (09) 770-780
• 8 O’Brien K, Poenaru D. Penetrating sledding injuries to the lower torso – 2 case reports. CMAJ 1999; 160 (03) 353-354
• 9 Zhang Q, Chen W, Smith WR et al. Superior gluteal artery injury presenting as delayed onset shock. Arch Orthop Trauma Surg 2010; 130 (02) 251-256
• 10 Lunevicius R, Schulte KM. Analytical review of 664 cases of penetrating buttock trauma. World J Emerg Surg 2011; 6 (01) 33
• 11 Ceyran H, Akcali Y, Ozcan N et al. Isolated penetrating gluteal injuries. Perspect Vasc Surg Endovasc Ther 2009; 21 (04) 253-256
• 12 Makrin V, Sorene ED, Soffer D et al. Stab wounds to the gluteal region: a management strategy. J Trauma 2001; 50 (04) 707-710
• 13 Mamode N, Reid AW. Haemorrhage following penetrating gluteal trauma. Br J Surg 1994; 81 (02) 203-204
• 14 van Oldenrijk J, Unlu C, van Wagensveld BA. Perforation of the ileum after a stab wound of the gluteal region: a case report. Emerg Med J 2007; 24 (10) 737-738
• 15 Corra S, de Giorgi F. Sledding injuries: is safety in this winter pastime overlooked? A three-year survey in South-Tyrol. J Trauma Manag Outcomes 2007; 1 (01) 5
• 16 Nicol AJ, Navsaria P. Penetrating Rectal Injuries. In: Velmahos GC, Degiannis E, Doll D, (eds). Penetrating Trauma. 1. ed. Heidelberg. New York: Springer; 2012: 397-400