Travmatik jejunoileal perforasyon nedeniyle cerrahi uygulanan hastaların klinik özelliklerinin değerlendirilmesi: 10 yıllık deneyim

Year 2023, Volume: 1 Issue: 1, 5 - 8, 28.02.2023

Mustafa Yeni , Mesud Fakirullahoğlu , Deniz Öcal

Abstract

Amaç: Bu çalışmada travma nedeniyle jejunum ve ileumda perforasyon nedeniyle cerrahi uygulanan hastaların klinik özellikleri araştırılmıştır.
Gereç ve Yöntem: Üçüncü basamak bir sağlık kuruluşunda Ekim 2012 ile Ekim 2022 tarihleri arasında travmatik jejunoileal perforasyon nedeniyle cerrahi uygulanan hastalar retrospektif olarak tespit edildi. Hastaların demografik verileri, travma verileri ve takip verileri araştırıldı. Travma türlerine göre komplikasyon ve mortalite durumu uygun istatistiki testler ile karşılaştırıldı.
Bulgular: Çalışma kriterlerine uyan 36 hasta mevcut olup hastaların 35’i (%97,2) erkek cinsiyette idi. Hastaların ortalama yaşı 37,16±14,68 yıl (18-75) idi. 29 (%80,6) hastaya penetran yaralanma nedeniyle ve 7 (%19,4) hastaya künt travma nedeniyle acil cerrahi uygulandı. 23 (%63,9) hastada jejunum perforasyonu ve 12 (%33,3) hastada ileum perforasyonu mevcuttu. Travma cerrahileri sırasında hiçbir hastaya ostomi açılması gerekmezken; 5 (%13,9) hastaya perforasyon alanı primer tamiri ve 30 (%86,1) hastaya yaralanan bağırsak segment rezeksiyon anastomozu uygulandı.
Postoperatif dönemde 12 (%33,3) hastada komplikasyon gelişmiş olup, künt travma sonrası komplikasyon oranı penetran travmadan daha yüksek idi (%71,4’ye karşın %24,1; p=0,029). Çalışmamızın mortalite oranı %2,8 olup, penetran travmaya bağlı mortalite künt travma mortalitesinden daha fazla olmasına rağmen istatistiki anlamlılık yoktu (%3,4’e karşın %0; p=1.000).
Sonuç: Bağırsak yaralanmaları künt veya delici karın yaralanmalarından kaynaklanabilen, kliniği travmanın cinsine ve şiddetine bağlı olarak değişkenlik gösteren bir klinik tablodur. İlk bakıda hastaların hemodinamik stabilite durumu değerlendirilmeli ve stabil olmayan hastalarda gerekli durumlarda acil laparotomi seçeneği akılda bulundurulmalıdır. Hemodinamik olarak stabil hastalarda ise görüntüleme yöntemlerine başvurulmalı ve görüntüleme yöntemlerinden elde edilen veriler doğrultusunda acil laparotomi ve ameliyatsız takip seçeneklerine başvurulmalıdır.

Keywords

Jejunum, ileum, intestinal perforasyon, morbidite, mortalite, Jejunums, intestinal perforation, morbidity, mortalities., mortalities

Evaluation of clinical features of patients who underwent surgery for traumatic jejunoileal perforation: 10 years of experience

Abstract

Objective: In this study, the clinical characteristics of patients who underwent surgery for perforation of the jejunum and ileum due to trauma were investigated.
Material and Method: Patients who underwent surgery for traumatic jejunoileal perforation in a tertiary healthcare institution between October 2012 and October 2022 were identified retrospectively. Demographic data, trauma data, and follow-up data of the patients were searched. Complication and mortality status according to trauma types were compared with appropriate statistical tests.
Results: There were 36 patients who met the study criteria, and 35 (97.2%) of the patients were male. The mean age of the patients was 37.16±14.68 years (18-75). Emergency surgery was performed in 29 (80.6%) patients due to penetrating injury and 7 (19.4%) patients due to blunt trauma. 23 (63.9%) patients had jejunum perforation, and 12 (33.3%) patients had ileum perforation. While no patient needs an ostomy during trauma surgeries, primary repair of the perforation area was performed in 5 (13.9%) patients, and intestinal segment resection anastomosis was performed in 30 (86.1%) patients.
Complications developed in 12 (33.3%) patients in the postoperative period and the complication rate after blunt trauma was higher than penetrating trauma (71.4% vs. 24.1%; p=0.029). The mortality rate in our study was 2.8%, and although mortality due to penetrating trauma was higher than blunt trauma mortality, it was not statistically significant (3.4% vs. 0%; p=1.000).
Conclusion: Intestinal injuries are a clinical picture that can be caused by blunt or penetrating abdominal injuries, the clinical picture of which varies depending on the type and severity of the trauma. The hemodynamic stability of the patients should be evaluated at the first examination, and the option of emergency laparotomy should be considered in unstable patients when necessary. In hemodynamically stable patients, imaging tools should be applied, and in line with the data obtained from imaging methods, emergency laparotomy and non-surgical follow-up options should be used.

Keywords

Jejunums, ileum, intestinal perforation, morbidity, mortalities

References

• Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4(3):129- 134. DOI: 10.4103/1947-2714.93889
• Kanté L, Togo A, Diakité I, et al. Plaies pénétrantes abdominales par armes dans le service de chirurgie générale du CHU Gabriel Touré. Mali Méd. 2013;28(3):28-31.
• Feliciano DV. Abdominal trauma revisited. Am Surg. 2017;83(11):1193-1202.
• Alexandropoulou C-A, Elias P. Wound ballistics: analysis of blunt and penetrating trauma mechanisms. Health Sci J. 2010;4(4):225-236.
• Iaselli F, Mazzei MA, Firetto C, et al. Bowel and mesenteric injuries from blunt abdominal trauma: a review. Radiol Med. 2015;120(1):21-32. DOI: 10.1007/s11547-014-0487-8
• Jeroukhimov I, Wiser I, Hershkovitz Y, et al. Frequency of intra-abdominal organ injury is higher in patients with concomitant stab wounds to other anatomical areas. BMC Emerg Med. 2018;18(1):1-5. DOI: 10.1186/s12873-018-0167-4
• Bloom MB, Ley EJ, Liou DZ, et al. Impact of body mass index on injury in abdominal stab wounds: implications for management. J Surg Res. 2015;197(1):162-166. DOI: 10.1016/j. jss.2015.03.052
• McMahon KR, Balasubramanya R. Intestinal Trauma. StatPearls [Internet]. StatPearls Publishing; 2022. Accessed Jan 2, 2023. https://www.ncbi.nlm.nih.gov/books/NBK557624/
• Shah SK, Uray KS, Stewart RH, Laine GA, Cox Jr CS. Resuscitation-induced intestinal edema and related dysfunction: state of the science. J Surg Res. 2011;166(1):120-130. DOI: 10.1016/j. jss.2009.09.010
• Kawahara NT, Alster C, Fujimura I, Poggetti RS, Birolini D. Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma. 2009;67(3):589-595. DOI: 10.1097/ TA.0b013e3181a60593
• Fakhry SM, Watts DD, Luchette FA, Group EM-IHR. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma. 2003;54(2):295-306. DOI: 10.1097/01.TA.0000046256.80836.AA
• Hoff WS, Holevar M, Nagy KK, et al. Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group. J Trauma. 2002;53(3):602-615. DOI: 10.1097/00005373-200209000-00038
• Velmahos GC, Constantinou C, Tillou A, Brown CV, Salim A, Demetriades D. Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management. J Trauma. 2005;59(5):1155-1161. DOI: 10.1097/01. ta.0000196435.18073.6d
• O’Malley E, Boyle E, O’Callaghan A, Coffey JC, Walsh SR. Role of laparoscopy in penetrating abdominal trauma: a systematic review. World J Surg. 2013;37(1):113-122. DOI: 10.1007/ s00268-012-1790-y
• Kirkpatrick AW, Baxter KA, Simons RK, Germann E, Lucas CE, Ledgerwood AM. Intraabdominal complications after surgical repair of small bowel injuries: an international review. J Trauma. 2003;55(3):399-406. DOI: 10.1097/01.TA.0000060248.87046.EE
• Cullinane DC, Jawa RS, Como JJ, et al. Management of penetrating intraperitoneal colon injuries: a meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2019;86(3):505-515. DOI: 10.1097/ TA.0000000000002146
• Talving P, Chouliaras K, Eastman A, et al. Discontinuity of the bowel following damage control operation revisited: a multi-institutional study. World J Surg. 2017;41(1):146-151. DOI: 10.1007/ s00268-016-3685-9
• Musau P. Risk indicators of morbidity and moratality in abdominal injuries. East Afr Med J. 2006;83(12):644-650. DOI: 10.4314/eamj.v83i12.9494
• Lone G, Peer G, Wani K, Bhat A, Wani N, Bhat M. An experience with abdominal trauma in adults in Kashmir. JK PRACTITIONER. 2001;8(4):225-230.