Pelvic Gunshot Wound
Single or multiple gunshot to pelvis causes penetration of bullets into pelvic bone and pelvic cavity. The complications observed following pelvic gunshot injury depends on extent of injury of pelvic bones and organs that lies within pelvic cavity. The gunshot bullet penetration injuries to pelvic bones and joint of pelvic girdle causes fracture of pelvic bones and dislocation of sacroiliac or hip joints.
Similarly, visceral organ injury within the pelvic cavity causes perforation and laceration of viscera as well as blood vessels that supplies blood to viscera. The peripheral or central nerve injury within pelvic cavity from gunshot wound causes sensory, motor or autonomic nerve damage resulting in numbness, muscles weakness and autonomic dysfunction. The soft tissue injury causes tear, laceration or perforation of subcutaneous tissue, muscles, ligaments and tendon.
The life threatening injury to pelvis from gunshot is caused by profuse bleeding that follows laceration or perforation of major artery and veins. The internal iliac artery is the major artery within pelvic girdle.
About Pelvis and Pelvic Cavity
Pelvis is also known as pelvic bone or bony pelvis. Pelvic bone is formed by sacrum, ilium, ischium and pubic bone. Sacrum is a flat triangular shaped bone that is connected to fifth lumbar vertebra at the top and coccyx at the bottom. Sacrum is the lowermost section of vertebral column. Vertebral column supports upper body. Sacrum joins iliac bone to form sacroiliac joint. Sacrum and sacroiliac joint forms the posterior section of bony pelvis. Anterior and lateral section of bony pelvis is formed by 3 fused bones known as ilium, pubic and ischium bone. Ilium is the largest and widest pelvic bone that spreads in fan shape on lateral side. The superior part of ilium is known as iliac crest.
One can feel iliac crest when hand is placed over the topmost part of hip. Ilium is fused with ischium which is inferior to ilium and ischium is fused with pubic bone which lies anteriorly. Individual sits on ischium and coccyx supported by muscles, subcutaneous tissue and skin. The lateral cup shaped hollow bony space of pelvic bone is known as acetabulum. Acetabulum is formed by fusion of ilium, ischium and pubic bone. Acetabulum holds head of femur to form hip joint. The sacrum, sacroiliac joint, ilium, pubic, ischium bone and hip joint forms pelvic girdle. The pelvic girdle encloses the pelvic cavity. Pelvic cavity is the continuation of abdominal cavity. Pelvic cavity holds viscera, nerves, arteries, vein, lymphatic vessels and soft tissue which include muscles, tendon and ligaments.
Pelvic Cavity, Viscera and Soft Tissue
Pelvic cavity holds several visceral organs or soft tissue. The posterior section of pelvis holds rectum and anus, which is lower section of gastrointestinal system. The anterior section of pelvic cavity in female holds urinary bladder and urethra. The middle section of pelvic cavity in female holds uterus, vaginal and on both side ovaries as well as fallopian tube. Similarly, in male the anterior and middle section is unified and holds prostate, ejaculatory duct and seminal vesicles. The major blood vessels which lies in pelvic cavity is internal iliac artery and vein. Internal iliac artery is a branch of common iliac artery. Aorta splits into right and left common iliac artery. Common iliac artery splits into internal iliac and external iliac artery. Internal iliac artery gives out several branches. The branches of internal iliac artery provide oxygenated blood and nourishment to pelvic bone, muscles, tendon, ligament, pelvic visceral organs and soft tissue. Internal iliac vein carries deoxygenated blood from organs, soft tissue and bones to heart.
The lymphatic fluid is carried to heart by lymphatic vessels.
Nervous system which lies in pelvis is sacral plexus and several nerves originates from sacral plexus. The sacral plexus supplies sensory and motor fibers to skin, subcutaneous tissue, muscles, ligaments, tendon and pelvic bone. The sympathetic and parasympathetic autonomic nerves are supplied to visceral organs, arteries, vein and lymphatic vessels. The sacral plexus is formed by sacral nerve 1 to 4. The sacral plexus forms a major nerve known as pudendal nerve. Pudendal nerve supplies sensory, motor and autonomic nerves to most viscera and soft tissue within pelvic cavity. The lowermost bundle of nerves is coccygeal plexus, which is formed by 4th sacral nerve and fist coccygeal nerve. Nerves from coccygeal plexus supplies sensory nerve to skin over coccyx. The laceration, tear or injury of sacral plexus or pudendal nerve causes numbness over perineum, scrotum and penis in male and perineum, vulva and clitoris in female. Injuries of motor nerve that is part of sacral plexus or pudendal nerve causes weak or paralyzed pelvic floor muscles. Pelvic floor muscles support internal organs like uterus, vagina, bladder, rectum and sphincters. The pelvic muscle weaknesses and paralysis causes bladder, rectum, uterus or vaginal prolapse. Pelvic muscle weaknesses result in constipation and urinary retention.
Complications & Recovery Following Pelvic Gunshot Wound
The extent of injury to pelvic girdle as well as soft tissue and visceral organ within pelvic cavity depends on single or multiple bullet penetration. The single bullet penetration may not be fatal if internal iliac artery is not lacerated or penetrated. The recovery is often near normal following single gunshot injury to pelvic. Serious complications are observed following multiple gunshot injury to the pelvic.