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Volume : 12 Issue : 3 Year : 2024

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Turkish Journal of Trauma and Emergency Surgery Our experience in the cases with penetrating colonic injuries [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. 2006; 12(3): 223-229

Our experience in the cases with penetrating colonic injuries

Mehmet Cemal Kahya, Hayrullah Derici, Necat Cin, Fatma Tatar, Yasin Peker, Hüdai Genç, Vedat Deniz, Enver Reyhan
Department Of 3rd. General Surgery, Atatürk Training And Research Hospital, İzmir, Turkey.

BACKGROUND: In this study, the factors that effect the morbidity and mortality in patients with penetrating colonic injuries were evaluated.
METHODS: Fourty-two patients (37 males, 5 females; mean age 30,1; range 14 to 63 years) with penetrating colonic trauma were evaluated according to age, gender, type of penetrating trauma, location and severity of the colonic injury, associated injury, interval between the trauma and the definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality.
RESULTS: Type of the penetrating trauma was stab injury in twenty-eight (67%) patients, and gunshot injury in fourteen (33%) patients. The mean Colon Injury Severity Score was 2,1. The mean Abdominal Trauma Index (ATI) was 17,2 and it was over than 25 in eight (19%) patients. The symptoms of shock were present in eleven (26%) patients at admission. Blood transfusions were applied in sixteen (38%) patients. In twenty-one patients intraabdominal bleeding was observed and it was more than 500 mL in eleven (26%) patients. Primary repair was performed in 36 (86%) of the 42 patients and colostomy was performed in six (14%) patients. Morbidity and mortality rates were 41% and 10% respectively.
CONCLUSION: It was found that morbidity rates were increased in patients with ATI score higher than 25, and mortality rates were increased in patients presenting shock at admission, with the amount of intraabdominal blood more than 500 mL, and who needed three or more units of blood transfusion. The primary repair of the penetrating colon trauma can be performed confidently in the hemodynamicaly stable patients with ATI score less than 25.

Keywords: Abdominal injuries/classification/complications, colostomy; Injury Severity Score; wounds, penetrating.

Penetran kolon yaralanmalı olgulardaki deneyimlerimiz

Mehmet Cemal Kahya, Hayrullah Derici, Necat Cin, Fatma Tatar, Yasin Peker, Hüdai Genç, Vedat Deniz, Enver Reyhan
Atatürk Eğitim ve Araştırma Hastanesi 3. Cerrahi Kliniği, İzmir.

AMAÇ: Penetran kolon yaralanmalı olgularda morbidite ve mortaliteye etkili faktörler araştırıldı.
GEREÇ-YÖNTEM: Kırk iki olgu (37 erkek, 5 kadın; ort. yaş 30,1; dağılım 14-63) yaş, cinsiyet, penetran travmanın türü, kolonda yaralanma yeri, kolon yaralanmasının şiddeti, ek organ yaralanması, yaralanmadan ameliyata kadar geçen süre, hemodinamik durum, kan transfüzyonu, fekal kontaminasyon, cerrahi işlem, ameliyat sonrası komplikasyon ve mortalite açısından incelendi.
BULGULAR: Olguların 28’inde (%67) kesici delici alet yaralanması, 14’ünde (%33) ateşli silah yaralanması vardı. Kolon yaralanma şiddeti skoru ortalaması 2,1 idi. Abdominal Travma İndeksi (ATİ) değeri ortalama 17,2 olup, sekiz olguda (%19) 25’in üzerindeydi. On bir olguda (%26) başvuru anında şok tablosu vardı; on altı olguya (%38) kan transfüzyonu yapıldı. Yirmi bir olguda karın içi hemoraji vardı ve bu durum on bir olguda (%26) 500 ml’nin üzerinde idi. Olguların 36’sına (%86) primer tamir, altısına (%14) stomalı ameliyatlar uygulandı. Morbidite ve mortalite oranları sırasıyla %41 ve %10 bulundu.
SONUÇ: Abdominal Travma İndeksi değerinin 25 ve üstünde olmasının morbiditeyi artırdığı; başvuru anında şok tablosu, ameliyatta karın içi serbest kan miktarının 500 ml’den fazla olması, üç ünite ve daha fazla kan transfüzyonu yapılmasının da mortaliteyi anlamlı olarak artırdığı bulundu. Hemodinamisi stabil ve ATİ skoru 25’in altında olan penetran kolon yaralanmalı hastalarda primer onarım güvenle uygulanabilir.

Anahtar Kelimeler: Abdominal yaralanma/sınıflama/komplikasyon, kolostomi; Yaralanma Ağırlık Skoru; yaralar, penetran.

Mehmet Cemal Kahya, Hayrullah Derici, Necat Cin, Fatma Tatar, Yasin Peker, Hüdai Genç, Vedat Deniz, Enver Reyhan. Our experience in the cases with penetrating colonic injuries. Ulus Travma Acil Cerrahi Derg. 2006; 12(3): 223-229

Corresponding Author: Mehmet Cemal Kahya, Türkiye
Manuscript Language: Turkish