Abstract

HERNANDEZ-TIRIA, María Camila; NAVARRO-DEVIA, Antonio José  and  OSORIO-RUIZ, Ana María. Vulvar and perineal injury secondary to complex pelvic and perineal trauma: case presentation and review of the literature. Rev Colomb Obstet Ginecol [online]. 2015, vol.66, n.4, pp.297-305. ISSN 0034-7434.  https://doi.org/10.18597/rcog.295.

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 post-menopausal 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.

Keywords : Wounds; trauma; vulva; genitalia; female; injuries; gynecology.

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