ÝNCE BARSAK YARALANMALARI

Cumhuriyet Üniversitesi Týp Fakültesi Genel Cerrahi Kliniðinde Ocak 1991 ile Ocak 1996 yýllarý arasýnda ince barsak yaralanmasý olan 50 hasta retrospektif olarak incelendi. Duedonum yaralanmalarýnýn teþhis ve tedavisi farklý özellikler gösterdiðinden bu gruba dahil edilmediler. Hastalarýn 45'i erkek 3'ü kadýndý, yaþ ortalamasý 34.6 (11-65) idi. Yaralanmalarýn 27 (%54)'si künt travmaya baðlýydý, 20 (%40)'si penetran yaralanma, penetran yaralanmalarýnda 5'i delici kesici alet yaralanmasý, 15'i ateþli silah yaralanmasýydý. 3(%6) olgumuzda iatrojenik yaralanma mevcuttu. Teþhiste direk grafi, bilgisayarlý tomografi (BT) kullanýldý. Periton lavajý ve ponksiyon hipovolemi belirtilerinden hipotansiyon ve taþikardisi olan hastalara yapýldý. Özellikle peritoneal irritasyon bulgularýn saptanmasý için fizik muayene sýk olarak tekrarlandý. 24(%48) olgumuzda diðer karýn içi organ yaralanmasý eþlik etmekteydi. Perforasyonlar 29 (%58)' unda primer olarak onarýldý, 19(%38)'unda rezeksiyon + anastomoz, 2(%4)'sinde rezeksiyon anastomoz ile birlikte primer sütür yapýldý. Çalýþmamýzda morbidite 16 (%32), mortalite 4 (%8) olarak bulundu. Exitus olan 4 hastanýn 3'ü künt travmaya maruz kalmýþtý ve bu hastalarýn ikisinde jeneralize peritonit hali mevcuttu, eþlik eden organ yaralanmasý yoktu. Künt travmaya baðlý ince barsak perforasyonlarýnda mortalitenin yüksek olmasýnýn nedeni tanýdaki gecikme olarak deðerlendirildi.

SMALL INTESTINAL INJURIES

50 patients with small intestinal injury were examined, between January 1991 and January 1996 in Cumhuriyet University Medidal Faculty General Surgery Department. Patients with duodenal traumas were excluded from this study, because of their different properties in diagnosis and treatment. 47 of the patients were men and 30 of them were women with a mean age of 34.6 (11-65) years. 27 (%54) of the injuries were due to blunt traumas and 20 (%40) were penetrating traumas. Five of the penetrating traumas were due to knife and 15 of them were due to gunshot. In 3 (%6) of them, traumas were because of the iatrogenic lacerations. In diagnosis direct X-Ray and computerized tomography were used. When there were hypotension and tachycardia diagnostic peritoneal lavage and parasenthesis were performed. Physical examination was often done to detect the peritoneal irritation. In 24 (%48) patients observed associated injuries observed. 29 (%58) of the perforations had simple closure while in 19 (%38) of them resection+anastomasis and in 2 (%4) of them resection + anostomasis + simple closure were performed. In this study morbidity was 16 (%32), and mortality 4 (%8). 3 of the 4 exitus patients had blunt traumas and two of them had generalized peritonitis and there was no associated injury. As a result we can say that high level of the mortality in small intestinal injuries was to delay in diagnosis.