Perineal trauma in men is a severe surgical emergency often underestimated, posing significant risks to vital and functional prognoses. The condition can lead to severe complications, including haemorrhaging, digestive issues, urinary problems, and sexual dysfunction. In sub-Saharan Africa, managing such trauma is complicated by delayed admissions, limited technical capabilities, and a shortage of specialized medical personnel. A recent study at Bouaké University Hospital sought to evaluate therapeutic outcomes and factors influencing surgical decisions in treating perineal trauma.
The study, conducted from January 2022 to December 2024, reviewed 31 cases of male patients admitted with perineal trauma. The patients had a mean age of 29.6 years, with the youngest being 6 years old and the oldest 90 years old. Road traffic accidents and assaults were identified as the primary causes of perineal trauma, accounting for 22.5% and 19.3% of the cases, respectively. The average time from injury to admission was 7.7 hours, highlighting the relatively prompt response in seeking medical care.
Surgical intervention was necessary for 26 patients, with 57.7% undergoing one-stage repairs and 26.9% requiring two-stage repairs. The decision-making process for surgical approaches was influenced by the severity of the injuries and the time elapsed before admission. The Rectum Injury Scale (RISS) of the American Association for the Surgery of Trauma was used to classify the severity of rectal injuries, ensuring a standardized assessment of trauma severity.
Postoperative morbidity was observed in 30.7% of the cases, primarily due to functional sequelae such as anal stenosis, urinary incontinence, and erectile dysfunction. Despite the complications, no deaths were recorded during the study period, indicating a positive outcome in terms of mortality. The study emphasized the importance of balancing anatomical repair with the prevention of septic risk in managing perineal trauma.
The management of perineal trauma in resource-limited settings like Bouaké involves a constant trade-off between anatomical repair and the prevention of septic risk. A simple decision-making algorithm, based on admission delay and injury severity, was proposed to achieve acceptable outcomes. This approach aims to optimize patient care by considering the specific challenges posed by limited resources.
The development of pelvic floor rehabilitation was identified as a major challenge to improve patients' quality of life. Functional sequelae, such as those observed in the study, underscore the need for comprehensive care that extends beyond immediate surgical interventions. Efforts to enhance rehabilitation services could significantly impact the long-term outcomes for patients with perineal trauma.
The study's findings contribute to the broader understanding of perineal trauma management in sub-Saharan Africa, highlighting the need for continued research and improvement in care protocols. By addressing the specific challenges faced in resource-limited settings, healthcare providers can work towards enhancing patient outcomes and reducing the long-term impacts of perineal trauma.
Key points
- A simple decision-making algorithm based on admission delay and injury severity can provide acceptable outcomes in managing perineal trauma in resource-limited settings.
