Case reports on penetrating buttock injury [6, 8, 19–33] highlight the importance of a thorough Compound C order and aggressive evaluation of the patient [6], observation [23, 27], prompt differential diagnosis [8, 21, 30, 31], immediate assessment of the lower urinary tract [21, 22], and lately the value of dynamic 2D and 3D CT-scanning and angiography [28]. They also highlight rare complications following high-velocity or low-velocity gunshot injury to the buttock where the bullet or pellet migrates to major veins such as inferior cava vein and hepatic veins [29] or if it reaches the right ventricle of the heart [23], needing a broad range

of approaches ranging from open surgery to angioembolization [6, 21, 22], transjugular ARN-509 manufacturer extraction of bullet from middle hepatic vein [29], image navigation surgery [33], gluteal surgery [28, 32], laparoscopy [24], and laparotomy [6, 20, 21, 25]. Our analytical review demonstrates that penetrating trauma to the buttock is a serious diagnostic and clinical concern with a mortality

rate of 2.9%. Mortality of penetrating stab injuries to the buttock is comparable to that of extra-buttock regions of the body, such as penetrating injury to the posterior abdomen is 0-2% [37–39], the anterior abdomen 0-4.4% [40–43], the thoracoabdominal area 2.1% [44], and the chest 2.5-5.6% [44–46]. Mortality may be less in cohorts with isolated stab injury to the chest (1.46%) [45], or after exclusion of cardiac injuries (0.8%) [44].

Regarding pelvic or transpelvic gunshot trauma, mortality rates vary from 0-12.2% [11, 47, 48]. Cohorts with gunshot wounds to the limbs may show no mortality [49, 50]. We conclude that penetrating injuries to the buttock poses a similar threat to the patient as penetrating trauma of any other body region. Despite the fact that stab wound primarily cause loco-regional damage, whilst gunshot trauma is buy CRT0066101 associated with frequent extraterritorial injury, stab wounds (3.8% mortality rate) are even more dangerous than missile wounds per se or gunshot wounds specifically (2.6% and 2.2% mortality rate, respectively). Injury of buttock due to impalement remains Resveratrol uncommon [26, 51]. It is therefore recommended to classify impalement related injuries as a separate category of penetrating injuries [52]. Analysis of the associated major injuries due to penetrating trauma to the buttock reveals several unexpected particularities. The most commonly damaged particular organs and vessels were, in descending order, small bowel, colon, superior gluteal artery, and rectum. Injury of iliac artery and/or vein was a rare, but relevant finding with 2.9%. This counterintuitive finding is better understood on analysis of subgroups created according to injury mechanism.