VASCULAR INJURIES DUE TO BLUNT ABDOMINAL TRAUMA

Abdominal vascular trauma is predominantly penetrating in nature with blunt injuries occurring less frequently. The various specific types of blunt abdominal vascular trauma have been individually reported, however, the wide spectrum of vascular pathology possible with blunt injury is relatively unknown. Over a five year period, 27 patients who sustained blunt abdominal vascular injury were identified. The injury was motor vehicle related in 25/27 (93%). Mean blood pressure on admission was 88/26 mm Hg and mean Injury Severity Score (ISS) was 28±8.2. In 27 patients, there was 19 arterial and 17 venous injuries diagnosed. Significant associated injuries were present in 26/27 (96%) patients. When arterial and venous injuries were compared, surgical treatment of arterial injuries more frequently required grafting or ligation, in contrast to venous injuries usually required ligation, packing, or primary repair. Overall morbidity (56%) was significantly greater in the group with venous injury (92% vs 46%, p<0.05). The overall mortality rate was 19%. There was no death in the group with major arterial injuries, while five patients (33%) with major venous injuries died (p< 0.05). Blunt abdominal vascular trauma is a rare entity with a wide spectrum of vascular injuries possible. Hypotension and associated visceral injuries are often present. Major venous injuries present acutely and despite heroic measures, continue to have a higher morbidity and mortality. Aggressive resuscitation should be followed by early surgical intervention keyed by a high index of suspicion.

KÜNT BATIN TRAVMALARINA BAÐLI DAMAR YARALANMALARI

Karýn içi damar yaralanmalarý sýklýkla delici ve kesici aletlerle olmakta, nadir de olsa künt travmalarý takibinde yaralanmalar meydana gelmektedir. Künt travmalar sonucu oluþmuþ damar yaralanmalarýna ait az sayýda yayýn vardýr. Geniþ bir yelpazeyi daðýlan künt travmalar da oluþan damar yaralanmalarýnýn sýklýðý bilinmemektedir. Beþ yýlý aþkýn süre içinde künt travmalar sonucu karýn içi damarlarda yaralanma oluþmuþ 27 hastanýn geriye dönük olarak týbbi dosyalarý tarandý. Bu yaralanmalarýn %93'ü (25/27) motorlu araç kazasýydý. Hastalarýn acil merkezimize geliþteki ortalama kan basýnçlarý 88/26 mm Hg'idi. Yaralanma ciddiyet skorlarý ortalamasý (ISS) 28±8.2 puan olan hastalarýn, 19'sunda arterial, 17 sinde venöz yaralanma mevcuttu. 26 hastada (%96) damar yaralanmalarýna, diðer karýn içi organ yaralanmalarý eþlik ediyordu. Arter yaralanmalarý için primer onarým ve ligasyon, venöz yaralanmalar için ise kompresyon, ligasyon ve/veya primer onanýn uygulandý. Kaba mortalite oraný %l 9 olarak bulundu. Arter yaralanmalarýnýn tek baþýna bulunduðu grupta ölüm yokken, mortalite venöz yaralanmalarý olan grupta 33% (5 hasta) olarak bulundu (p<0.05). Nadir de olsa künt batýn travmalarý sonucu batýn içi damar yaratanýndan oluþmaktadýr. Eþlik eden organ yaralanmalarýný takiben hemodinamik deðiþikler oluþmakta ve tüm müdahalelere raðmen yüksek mortalite ve morbiditiye neden olmaktadýr. Büyük ven yaralanmalarý ise yüksek olan mortaliteyi daha da arttýrmaktadýr. Bu nedenle hemodinamik olarak stabil olmayan hastalar resüsitasyon uygulandýktan sonra acil operasyona alýnmalý ve damar yaralanmasý yönünden dikkatli olunmalýdýr.