چکیده:
ﻣﻘﺪﻣﻪ : ﺗﺮوﻣﺎی ﭘﺮﯾﻨﻪ، ﯾﮏ ﻣﺸﮑﻞ راﯾﺞ در ﻃﯽ درﮔﯿﺮی ﻫﺎی ﻋﻤﻠﯿﺎﺗﯽ اﺳﺖ ﮐﻪ از اورژاﻧﺲ ﻫﺎی ﺟﺮاﺣﯽ ﻣﯽ ﺑﺎﺷﺪ . ﮔﺰارش ﻣﻮردی : در اﯾﻦ ﮔﺰارش ﺑﯿﻤﺎر آﻗﺎی 25 ﺳﺎﻟﻪ ﺑﻪدﻧﺒﺎل ﺗﺮوﻣﺎی ﻧﺎﻓﺬ در اﺛﺮ ﺗﯿﺮﺧﻮردﮔﯽ ﻟﮕﻦ ﺑـﻪ ﺑﯿﻤﺎرﺳﺘﺎن ﻣﺮاﺟﻌﻪ ﮐﺮده ﺑﻮد . در ﺑﺮرﺳﯽ درد ﺷﺪﯾﺪ، اﻓﺖ ﻫﻤﻮﮔﻠﻮﺑﯿﻦ و ﮐﺎﻫﺶ ﻓﺸﺎرﺧﻮن داﺷﺖ . ﺑﻼﻓﺎﺻﻠﻪ ﺗﺤﺖ ﺟﺮاﺣﯽ اورژاﻧﺴﯽ ﻗﺮار ﮔﺮﻓﺖ . در ﺣﯿﻦ ﺟﺮاﺣﯽ ﺗﺨﺮﯾﺐ ﮐﺎﻣﻞ ﺑﯿﻀﻪ راﺳﺖ، ﻗﻄﻊ رﯾﺸﻪ ﭘـﻨـﯿـﺲ و ﻣﺠﺮای ادراری، ﭘﺎرﮔﯽ وﺳﯿﻊ ﻣﺜﺎﻧﻪ، ﭘﺎرﮔﯽ اﯾﻠﯿﻮم و ﺣﺪود دو ﻟﯿﺘﺮ ﺧﻮن در ﻓﻀﺎی ﭘﺮﯾﺘﻮﺋﻦ ﻣﺸﺎﻫﺪه ﺷـﺪ . رزﮐﺴﯿﻮن و آﻧﺎﺳﺘﻮﻣﻮز روده و ﺗﺮﻣﯿﻢ ﻋﺮوق ﺷﮑﻤﯽ اﻧﺠﺎم و ﭘﺎرﮔﯽ ﻣﺜﺎﻧﻪ ﺗﺮﻣﯿﻢ ﮔﺮدﯾﺪ . ﺗﺮﻣﯿﻢ ﻣـﺠـﺮای ادراری و ﭘﻨﯿﺲ اﻧﺠﺎم ﺷﺪ. ﺑﯿﻀﻪ راﺳﺖ ﺑﺮداﺷﺘﻪ ﺷﺪ و در ﭘﺎﯾﺎن درن ﺳﯿﺴﺘﻮﺳﺘﻮﻣﯽ ﻓﯿﮑﺲ و ﺟﺪار ﺗﺮﻣﯿﻢ ﮔﺮدﯾﺪ. در ﻣﺪت ﭘﯿﮕﯿﺮی ﺑﯿﻤﺎر ﻣﺸﮑﻞ ادراری ﻧﺪاﺷﺖ و ﻧﯿﺰ دارای ارﮐﺴﯿﻮن ﻃﺒﯿﻌﯽ ﺑﻮد. ﻧﺘﯿﺠﻪ ﮔﯿﺮی : اﯾﻦ ﮔﺰارش ﻧﺸﺎن داد ﮐﻪ اﻧﺠﺎم ﺟﺮاﺣﯽ اورژاﻧﺴﯽ ﺑﺼﻮرت ﺗﯿﻤﯽ در ﮐـﻤـﺘـﺮﯾـﻦ زﻣـﺎن ﻣﻤﮑﻦ، ﻣﯽ ﺗﻮاﻧﺪ ﺳﺒﺐ ﺗﺮﻣﯿﻢ ﮐﺎﻣﻞ آﺳﯿﺐ ﻟﮕﻨﯽ و اﻧﺪام ﺗﻨﺎﺳﻠﯽ ﻧﺎﺷﯽ از ﺗﺮوﻣﺎی ﺳﻼح ﮔـﺮم ﺷـﻮد؛ و ﺑﯿﻤﺎر ﺑﻌﺪ از 7 ﻣﺎه ﭘﯿﮕﯿﺮی دارای وﺿﻊ ﻋﻤﻮﻣﯽ ﭘﺎﯾﺪار و ﺑﺪون ﻣﺸﮑﻼت ادراری و ﺟﻨﺴﯽ ﺑﻮد .
Background: Perineal trauma is a common problem during opera-tional conflicts that is a surgical emergency.
Case report: In this case report, a 25-year-old man was referred to our hospital because of penetrating trauma caused by gunshot. The patient had severe pain, decline of hemoglobin and decreased blood pressure. An emergency surgery was performed immediately. During surgery, a complete destruction of the right testis, cutting the root of the penis and urethra, bladder large rupture, the rupture of the ileum and approximately two liters of blood in the peritoneal space was ob-served. Resection and the anastomosis of bowel were done, and ab-dominal vascular and bladder rupture were also repaired. His penis and urinary tract were repaired, as well. Right testis was removed and the cystostomy drain was fixed and the wall was repaired. The patient did not have urinary problems and his erection was normal during follow-up period.
Conclusion: This report showed that the multidisciplinary emer-gency surgery during the least possible time can lead to complete re-pair of extensive injury to the pelvis and genitalia following gunshot trauma, and the patient had normal and stable condition without any urinary and sexual disorder in seven months follow-up.