THE COMPARISION OF DIAGNOSTIC PERITONEAL LAVAGE AND DIAGNOSTIC LAPAROSCOPIC FINDINGS IN ABDOMINAL TRAUMA

In our study, among 40 patients who were admitted to the Emergency Surgery Unit of Istanbul Medical Faculty from June 1994 to May 1995, as an invasiv diagnostic procedure only peritoneal lavage (DPL) was performed for 15 patients and only laparoscopy (DL) was performed for 15 of them, but first DPL and subsequent DL were performed for the rest 10 patients. Among 25 DPL patients positive lavage result rates indicating laparotomy was found in 12 patients (48 %) and lavage results were considered as negative for 13 patients (52%). Eleven laparotomies were performed for lavage positive patients (44%). In one patient (4%) non-bleeding minor hepatic trauma was diagnosed by laparoscopy and laparotomy was cancelled. No laparotomy was necessary during the follow-up for 9 lavage negative patients (36%). Laparotomy was necessary for 4 of them (16%) for different purposes. In 10 DL patients (40%) laparotomy was indicated and laparotomy was performed for all of them. There were no findings requiring laparotomy among the rest 15. One of them (4%) was diagnosed with non-bleeding minor hepatic trauma. Retroperitoneal duodenal rupture was diagnosed by laparotomy in another patient (4%) later on. No complications were recorded among DPL patients while there were two pneumothorax cases among DL patients with diaphragmatic injury.

KARIN TRAVMALARINDA DÝAGNOSTÝK PERÝTONEAL LAVAJ ÝLE DÝAGNOSTÝK LAPAROSKOPÝNÝN KARÞILAÞTIRILMASI

Çalýþmamýzda Haziran 1994-Mayýs 1995 tarihleri arasýnda, künt ve penetran karýn travmasý nedeniyle Ýstanbul Týp Fakültesi Acil Cerrahi Ünitesine baþvuran 40 hastadan 15 tanesine invaziv taný yöntemi olarak sadece peritoneal lavaj (DPL), 15 tanesine sadece laparoskopi (DL), 10 tanesine ise önce DPL ardýndan DL yapýldý. DPL yapýlan 25 hastanýn 12 tanesinde (%48) laparotomi endikasyonu koydurtacak pozitif lavaj bulgularý saptandý. 13 tanesinde (%52) ise lavaj sonuçlarý negatif olarak deðerlendirildi. Lavaj sonucu pozitif olan hastalardan 11 tanesine (%44) terapötik laparotomi uygulandý, 1 tanesinde (%4) ise daha sonra yapýlan laparoskopiyle kanamasý durmuþ minör karaciðer yaralanmasý saptanarak laparotomiden vazgeçildi. Lavaj sonucu negatif bulunan vakalarýn 9 tanesinin (%36) sonraki takiplerinde de laparotomi gerekmedi. 4 tanesinde (%16) ise çeþitli sebeplerle laparotomi yapýldý. DL yapýlan 25 hastanýn 10 tanesinde (%40) laparotomi endikasyonu koydurtacak bulgular saptandý ve hepsine terapötik laparotomi uygulandý. 15 hastada ise laparotomi endikasyonu koydurtacak bulguya rastlanmadý. Bunlardan 1l tanesi (%4) kanamasý durmuþ minör karaciðer yaralanmasý idi. l hastanýn ise (%4) daha sonraki takibinde laparotomi gerekti ve retroperitoneal duodenum rüptürü saptandý. DPL yapýlan vakalarda hiç komplikasyon görülmezken, DL yapýlan diyafragma yaralanmak 2 (%8) hastada pnömotoraks geliþti.