Experience report of bladder injuries due to gunshot wounds in Syrian refugees

Purpose: To report our recent experience of bladder injuries due to gunshot in the Syrian conflict and the review literature regarding diagnosis and treatment.
Materials and Methods: We report 22 cases with abdominal and inguinal firearm wounds and bladder rupture sustained in the Syrian conflict.Age,mechanism/location of damage, associated injuries,Revised Trauma Score (RTS),Injury Severity Score (ISS),Trauma Injury Severity Score(TRISS),and complications were analyzed. Severity of bladder injuries is classified according to the American Association for the Surgery of Trauma Organ Injury Scaling(AAST-OIS grade ≥II database).Type of the bladder rupture is defined according to the classification System for Bladder Injury Based on Findings at CT Cystography.
Results and Conclusions: Mean age was 26 years(range 18 to 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 17 type 2, 3 type 4,and 2 type 5 bladder injuries. According to AAST-OIS there were 9 grade IV,6 grade III, 5 grade II,and 2 grade V injuries. In war settings when injuries are often severe and multiple,surgical exploration and closure is mandatory.Mortality risk was associated with high ISS,low TRISS and low RTS values.