Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 155-159

Künt karýn travmalý pediyatrik hastalarda ultrasonografiyle saptanan pelvik sývýnýn klinik önemi

Murat Orak¹, Mehmet Üstündað¹, Cahfer Güloðlu¹, Mehmet Tahir Gökdemir², Mehmet Özgür Erdoðan², Behçet Al^3
1Dicle Üniversitesi Týp Fakültesi, Acil Týp Anabilim Dalý, Diyarbakýr, Türkiye
²Þanlýurfa Eðitim Ve Araþtýrma Hastanesi, Acil Týp Kliniði, Þanlýurfa, Türkiye
³Gaziantep Üniversitesi Týp Fakültesi, Acil Týp Anabilim Dalý, Gaziantep., Türkiye

AMAÇ
Bu çalýþmada, pediyatrik künt batýn travmalý hastalarda organ hasarýnýn bir göstergesi olarak ultrasonografiyle saptanan pelvik sývý varlýðýnýn önemi deðerlendirildi.
GEREÇ VE YÖNTEM
Ocak 2008 ve Aralýk 2008 tarihleri arasýnda Dicle Üniversitesi Týp Fakültesi Hastanesi Acil Servisine künt karýn travmasý ile baþvuran ardýþýk 85 pediyatrik hastanýn kayýtlarý geriye doðru deðerlendirildi. Hasta yaþý, cinsiyeti, yaralanma mekanizmasý, izole yaralanmalar, cerrahi giriþimler, hastaneye yatýþ ve mortalite mayi yerleþimine göre deðerlendirildi.
BULGULAR
Künt karýn travmasý olan toplam 85 pediyatrik hasta (63 erkek, 22 kýz; ortalama yaþ 7,88±3,403 yýl) bu çalýþmaya dahil edildi. Hastalarýn %40’ýnda intraperitoneal sývý, %60’ýnda pelvik sývý vardý. Hastalarýn çoðu (%35,3) yüksekten düþme nedeni ile baþvurmuþlardý. Yaralanma mekanizmasý ile sývý varlýðý ve sývý yerleþimi arasýndaki fark istatistiksel olarak anlamlý deðil idi (p>0,05). Yirmi dokuz hastada solid organ yaralanmasý vardý. Ýntraperitoneal sývýyi en çok arttýran dalak yaralanmasý idi (p<0,001). Hastalarýn %15,3’üne laparotomi yapýldý (bunlarýn tümünde intraperitoneal sývý vardý) %44,7 hasta kan transfüzyonuna ihtiyaç duydu. Ýntraperitonal sývý varlýðý laparotomi olasýlýðýný ve kan transfüzyon ihtiyacýný istatistiksel olarak artýrmýþtý (p<0,001). Mortalite oraný %4,8 idi.
SONUÇ
Ultrasonografi incelemesinde pelvik sývý varlýðýnda solid organ yaralanma olasýlýðý daha düþük iken, pelvis dýþý intraperitoneal sývý varlýðýnda solid organ yaralanma olasýlýðý daha yüksektir.

Anahtar Kelimeler: Acil servis, sývý yerleþimi; organ yaralanmasý; pediyatrik travma; ultrasonografi.

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Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma

Murat Orak¹, Mehmet Üstündað¹, Cahfer Güloðlu¹, Mehmet Tahir Gökdemir², Mehmet Özgür Erdoðan², Behçet Al^3
1Dept. Of Emergency Medicine (em), Dicle University Faculty Of Medicine, Diyarbakir, Turkey
²Dept. Of Em, Þanlýurfa Training And Research Hospital, Sanliurfa, Turkey
³Dept. Of Em, Gaziantep University Faculty Of Medicine, Gaziantep, Turkey.

BACKGROUND
The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma.
METHODS
We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid.
RESULTS
A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88±3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%.

CONCLUSION
In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.

Keywords: Emergency department, fluid location; organ injury; pediatric trauma; ultrasonography.

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ATIF KOPYALA