Surgery of military injuries of the perineum (review)

Abstract

AIM: to analyze literature on perineal military injuries. PATIENTS AND METHODS: a search of sources was carried out using eLIBRARY.RU and the PubMed.gov using the keywords: “perineal wounds”, “rectal wounds”, “perineal trauma”, “perineum injury”, “rectal injuries”, “perineum trauma” for the last 10 years. RESULTS: recently, the main method for military injuries of the perineum with damage to the extraperitoneal part of the rectum is the 4D method: diverting stoma, elimination of the rectal defect, presacral drainage and distal lavage of the rectum, as well as primary surgical treatment of the wound with subsequent sanitation. For such injuries received in peacetime, the authors are inclined to a more differentiated approach, which usually differs from the 4D concept. It is worth noting that the methods and results of treating perineal wounds received in peacetime cannot be unambiguously projected onto the treating of military injuries. This is due to the morphological features of perineal wounds received in military actions. CONCLUSION: perineal injuries occur in approximately 5.4% of cases of total military actions. The most pressing problem is combined trauma of the extraperitoneal part of the rectum. The generally accepted conception was developed during the Vietnam War. Since then, the approach has not changed crucially, and most studies are, as a rule, descriptive in nature and do not provide clear recommendations for treatment.