ANAL CANAL - PERINEAL INJURIES

Anal canal - perineal injuries (ACPI) may pose challenging diagnostic and therapeutic dilemmas. These massive soft - tissue injuries overlie fractures of the pelvis and femur, and may involve pelvic floor, rectum and genitourinary tract. Over the last 10 years, 21 patients with complex ACPI managed at Department of General Surgery, University of Çukurova, School of Medicine was reviewed retrospectively. The effects of age, sex, mechanism of the injury, additional injuries, missing time from injury to therapy, the surgical procedures on the development of morbidity were statistically evaluated by using chi-square and Fischer exact tests. Delayed surgical therapy more than 24 hours and the presence of pelvic fractures were the significant factors on morbidity (p<0.05). Total complication rate was 80 %. Sphincter failure was detected in 9 cases, primary repair was performed only in 2. We conclude that total diversion of fecal stream, radical initial debridement of necrotic soft - tissue, exhaustive irrigation of the perineal wounds, parenteral antibiotic therapy, nutritional support, and appropriate management of bone injuries and skin grafts optimize recovery this devastating injury.

ANAL KANAL VE PERÝNE YARALANMALARI

Anal kanal - perine yaralanmalarý (AKPY) taný ve tedavi aþamasýnda zorluklara sahiptir. Beraberinde sýklýkla pelvis, rektum ve genito-üriner yaralanmalarýn bulunmasý morbidite ve mortalite oranlarýný artýrmaktadýr. Bu çalýþmada AKPY nedeniyle son 10 yýllýk dönem içinde Çukurova Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý'nda tedavi edilen 21 olgu yaþ, cinsiyet, yaralanma sekli, yaralanma anýndan tedaviye dek geçen süre, ek organ yaralanmalarý varlýðý ile uygulanan cerrahi prosedürler açýsýndan retrospektif olarak incelendi. Bu parametrelerin morbidite ve mortalite geliþimine etkisi chi-kare ve Fischer kesin olasýlýk testleri ile deðerlendirildi. Yaralanma anýndan 24 saat geçtikten sonra baþvuran olgular ile pelvik fraktürü mevcut olanlarda geliþen morbidite istatistiksel olarak anlamlý bulundu (p<0.05). Postoperatif komplikasyon oraný % 80 olarak saptandý. Sfinkter hasarý 9 olguda gözlendi, 2 olguda primer tamir uygulandý. AKPY nedeni ile baþvuran olgularda kolostomi, nekrotik dokularýn radikal debritmaný, geniþ spektrumlu antibiyotik tedavisi, nutrisyonel destek, uygun olgularda primer sfinkter onarýmý, kemik kýrýklarýnýn uygun ve erken tedavisi ile komplikasyon oranlarýnýn daha azaltýlacaðý inancýndayýz.