KÜNT TRAVMAYA BAÐLI ÝZOLE ÝNCE BARSAK YARALANMALARINDA CERRAHÝ TEDAVÝ

Ocak 1985-Aralýk 1996 arasýnda Erciyes Üniversitesi Týp Fak. Genel Cerrahi Kliniðinde künt travmaya baðlý 38 izole ince barsak yaralanmalý hasta araþtýrýldý. Travma nedeni 23 hasta ile en sýk trafik kazalarýna baðlý idi (%60). Fizik muayenede 27 hastada (%71.1) akut karýn bulgularý vardý. Ultrasonografi (USG) tüm hastalara uygulandý ve sekiz hastada karýnda serbest sývý kolleksiyonu tespit edildi. Diagnostik Peritoneal Lavaj 19 hastaya (%50) uygulandý ve iki hastada yalancý negatif sonuç alýndý. Hastalarýn 21 'inde bir veya daha fazla ekstraabdominal organ yaralanmasý vardý (%55.3). 27 hasta (%71.1) travmadan sonraki ilk 12 saatte operasyona alýndý. Yaralanmanýn lokalizasyonu, 15 hastada jejunum (%39.5), 17 hastada ileum (%44.7) ve 6 hastada multipl (%15.8) idi. Tedaviye 23 hastaya (%60.5) devaskülarize dokularýn debridmaný ve primer onarým uygulanýrken, 14 hastaya (%36.9) rezeksiyon + primer anastomoz uygulandý. Bir hastaya (%2.6) rezeksiyondan sonra ileostomi açýldý. Postoperatif dönemde bir hastada intraabdominal abse, iki hastada yara enfeksiyonu geliþti. 5 hasta (%13.2) ekstraabdominal majör travmalara baðlý olarak kaybedildi. Künt travmaya baðlý izole ince barsak yaralanmalarýnda taný koyma güçlüðü vardýr. Diagnostik Peritoneal Lavaj taný deðeri yüksek bir metoddur. Tedavide amaç devaskülarize dokularýn debridmaný sonrasý primer tamir veya rezeksiyon + primer anastomozdur. Mortalite genellikle ekstraabdominal yaralanmalara baðlýdýr.

SURGICAL MANAGEMENT ISOLATED SMALL BOWEL INJURIES DUE TO BLUNT TRAUMA

Between January 1985-February 1996 38 patients with isolated small bowel injuries due to blunt trauma were evaluated in Erciyes University Medical School General Surgery department The most frequent reason of the trauma was traffic accident with 23 patients (60.5%). 27 patients (71.1%) had acute abdomen in physical examination. Ultrasonography of the abdomen was performed in all patients, and was positive for intraabdominal fluid in eight patients. Diagnostic peritoneal lavage performed to 19 patients (50%) and showed two false negative results. One or more extraabdominal organ injuries occured in 21 patients (55.3%). 27 patients (71.1%) were accepted to the operation in the initial 12 hours of the trauma. The site of injury was jejunum 15 (39.5%), ileum 17 (%44.7%), multiple sites 6 (15.8). In operation debridement of devascularized tissue and primary sutur performed to 23 patients (60.5%) while 14 patients (36.9%) had resection + primary anastomosis. After resection, ileostomy was performed to one patient (2.6%). In the postoperative period, in one patient intraabdominal abscess and in two patients wound infection occurred. Five patients (13.2%) died because of extraabdominal major trauma. Diagnosis of the small bowel injuries due to blunt trauma is dificult. Peritoneal lavage is valuable a diagnostic method. Debridement of devascularized tissues and primary sutur or resection + primary anastomosis is the goal of the treatment. Mortality usually depends on the extraabdominal injuries.