A practice report of bladder injuries due to gunshot wounds in Syrian refugees.

Abstract

This study was intended to report our recent experience of bladder injuries due to gunshots in the Syrian conflict and review the literature regarding diagnosis and treatment. Twenty-two cases with abdominal and inguinal firearm wounds and bladder ruptures sustained in the Syrian conflict were reported. Age, mechanism/location of damage, associated injuries, Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), and complications were analyzed. The severity of the bladder injuries was classified according to the American Association for the Surgery of Trauma Organ Injury Scaling (AAST-OIS grade ?II database).The type of the bladder rupture was defined according to the classification System for Bladder Injury Based on Findings at CT Cystography. The mean age was 26 years (range, 18-36). The mean ISS was 22 (10-57), mean TRISS was 0.64 (0.004-0.95), and mean RTS was 6.97 (3.30-7.84). In the mortality group, the mean ISS, TRISS, and RTS were 48 (36-57), 0.016 (0.004-0.090), and 4.10 (3.30-4.92), respectively; whereas, the mean ISS, TRISS, and RTS were found as 21 (10-26), 0.64 (0.49-0.95), and 7.24 (5.65-7.84), respectively in the survival group (P=0.06). CT-cystography showed seventeen type 2, three type 4, and two type 5 bladder injuries. According to AAST-OIS, there were nine grade IV, six grade III, five grade II, and two grade V injuries. In war settings, when injuries are often severe and multiple surgical exploration and closure are mandatory, mortality risk is associated with high ISS and low TRISS and RTS values.