[Perineal injuries in wartime]

Abstract

Perineal war wounds involve the anterior perineum or urogenital perineum and posterior perineum or ano-sphincteric perineum. They are rare in civilian practice and in war practice, as only a small and hidden surface of this anatomical region is exposed to damaging agents. An isolated wound of the perineum is rarely life-threatening, but always threatens the functional prognosis of these patients, who have a mean age less than 30 years. In war practice, these wounds are often associated with lesions of adjacent of sacral, buttock or abdomino-pelvic regions. This article is confined to perineal war wounds in men. Lesions of the urethra and anus and rectum, as well as lesions of the genital appendages and pelvic nerves, leave micturating, gastrointestinal and sexual sequelae, which are sometimes permanent. These sequelae must not be exacerbated during investigation and surgical repair, despite the unfavourable emergency context, associated lesions and the time required to repair them. The basic principles of surgical treatment remain urinary diversion by a large cystostomy tube for urogenital lesions, faecal diversion by terminal colostomy for ano-sphincteric lesions, conservative debridement of the margins of the anal or urethral wound, debridement and drainage of contaminated soft tissues and connective tissue spaces. First-line immediate suture of the urethra or edges of the anal wound must be considered according to the defect, and the septic and haemorrhagic context. When ideal repair cannot be performed, alignment over an urethral catheter, urethrostomy, fixation-identification of the urethral or anal extremities constitute intermediate procedures allowing secondary urological and proctological specialized procedures in these patients.