Management of gunshot wounds to the perineum

The management of gunshot wounds involving the perineum depends upon the timely and accurate diagnosis of these lesions as well as early, definitive management. Usually the diagnosis is not difficult to make; however, a high index of suspicion must be maintained as an occult rectal injury is very often fatal. Management consists of debridement, presacral drainage, diverting colostomy, and distal washout in high velocity wounds, depending on the structures injured.