Ulus Travma Acil Cerrahi Derg. 2009; 15(1): 45-51

Penetran ince barsak yaralanmalarýnda ek organ yaralanmasýnýn morbidite ve mortalite üzerine etkisi

Mehmet Uludað, Gürkan Yetkin, Bülent Çitgez, Faruk Yener, Ýsmail Akgün, Arslan Çoban
Þiþli Etfal Eðitim Ve Araþtýrma Hastanesi 2. Genel Cerrahi Kliniði

AMAÇ: Ýnce baðýrsak yaralanmalarýnda ek organ yaralanmasý varlýðýnýn komplikasyon ve mortalite üzerine etkileri deðerlendirildi. GEREÇ VE YÖNTEM: 2000-2005 yýllarý arasýnda kliniðimizde penetran karýn yaralanmasý sonucu ince baðýrsak yaralanmasý olan hastalar iki gruba ayrýlarak deðerlendirildi. Grup I’de izole ince baðýrsak yaralanmalarý, grup II’de diðer karýn organlarý ile birlikte ince baðýrsak yaralanmasý olan hastalar toplandý. Bu iki gruptaki hastalarýn verileri karþýlaþtýrýldý. BULGULAR: Yaþ ortalamasý 38,1±8,86 (daðýlým 17-53) olan 38 hastada (34E, 4K) ince baðýrsak yaralanmasý saptandý; olgularýn 20’si grup I’de, 18’i grup II’de yer aldý. Ýki grubun sýrasý ile PATI (penetrating abdominal trauma index) deðerleri 6,2±2,58, 17±6,36 idi, grup II’de anlamlý olarak daha yüksekti (p<0,001). Toplam komplikasyon oraný %23,68 bulundu; grup I’de %5, grup II’de %44,8 olup anlamlý olarak yüksekti (p<0,01). Yatýþ süresi grup II’de anlamlý olarak yüksekti (grup I: 5,95±4,63 gün, grup II: 9,38±3,8 gün) (p<0,01). Mortalite oraný %2,63 olup, ince baðýrsak yaralanmasýna baðlý deðildi. SONUÇ: Ýzole ince baðýrsak yaralanmalarý düþük komplikasyon oranlarý ile tedavi edilebilir. Ýnce baðýrsak yaralanmalarýnda ek organ yaralanmasýnýn varlýðý komplikasyon geliþimini arttýrmaktadýr. Yaralanma Þiddeti Ölçeði (ISS) ve PATI skorlarý komplikasyon geliþimi riskini tahmin etmede kullanýlabilir.

Anahtar Kelimeler: Komplikasyon; penetran yaralanma; ince baðýrsak yaralanmasý; travma; travma skorlama sistemleri.

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Effects of additional intra-abdominal organ injuries in patients with penetrating small bowel trauma on morbidity and mortality

Mehmet Uludað, Gürkan Yetkin, Bülent Çitgez, Faruk Yener, Ýsmail Akgün, Arslan Çoban
Department Of 2nd General Surgery, Sisli Etfal Training And Research Hospital

BACKGROUND: We aimed to evaluate the effects on morbidity and mortality of additional organ injuries obtained concurrently with penetrating small bowel injuries. METHODS: Between January 2000 and March 2005, patients in whom penetrating small bowel injuries occurred as a result of abdominal injuries were allocated into two groups and assessed. The first group included patients with isolated small bowel injuries, while those in the second group had small bowel injuries together with other intra-abdominal organ injuries. RESULTS: Small bowel injury was identified in 38 patients (34 M, 4 F) with an average age 38.1±8.86 (17-53) years (Group I: 20 patients; Group II: 18 patients). The PATI (penetrating abdominal trauma index) values of the first and second groups were 6.2±2.58 and 17±6.36, respectively, and the difference was statistically significant (p<0.001). Complication rates were 23.68% for the whole group, 5% in group I and 44.8% in group II. The rate was significantly higher in group II (p<0.01). Mortality was 2.63% and it was not related to intestinal injury. CONCLUSION: Isolated penetrating small bowel injuries are amenable to treatment with lower complication rates. Additional organ injury increases the development of complications. Injury severity score (ISS) and PATI may be useful for estimating the risk of development of complications.

Keywords: Complication; penetrating injury; small bowel injury; trauma; trauma scoring system.

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