Çocuklarda dalak yaralanmalarının geriye dönük değerlendirilmesi: Tek bir merkezde on yıllık deneyim

Abstract

Amaç: Son on yılda dalak yaralanmaları nedeniyle kliniğimize başvuran çocuklarda dalak ve beraberindeki organ yaralanmalarına neden olan travma nedenlerini, tedavi tiplerini ve tedavi sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: Haziran 2011-Mayıs 2021 tarihleri arasında künt karın travmasına bağlı dalak yaralanması nedeniyle tedavi edilen 76 (56 erkek,20 kız) hastanın raporları retrospektif olarak incelendi. Bulgular: Hastaların yaşları 2-17 (8.7±5.4) arasında; 56'sı (%73.7) erkek, 20'si (%26.3) kız idi. Yaralanmaların nedenleri arasında motorlu taşıtla ilgili kazalar (%37,48,7), yüksekten düşme (%21,27,6), spor/engellere çarpma (%14,18,3), karın duvarına bir nesnenin çarpması(%3,3,9), atın tekme atması 1 (%1,3) yer aldı. 42 hastada (%55.3) izole dalak yaralanması mevcutken, 34 hastada (%44.7) başka organ yaralanmaları vardı. Dalak yaralanmaları 9’ unda grade I (%11.8), 18’ inde grade II (23.7.% ), 272 sinde grade III (%35.6), 19’ unda grade IV (%25) ve 3’ünde grade V (%3.9) idi. Hemodinamik instabilite nedeniyle üç hastada (%3.9) splenektomi ve iki hastada (2.6%) incebarsak yaralanması nedeniyle incebarsak onarımı yapıldı. Bu hastaların hiçbiri dalak yaralanmasından ölmedi, ancak hastalarımızdan biri ameliyatsız tedavi sırasında beyin hasarından öldü. Sonuç: Dalak yaralanması olan ve hemodinamik olarak stabil olan hastalarda konservatif tedavi yöntemleri seçilmelidir. Hastanede kalış süresinin kısalması, kan transfüzyonu gereksiniminin azalması ve morbidite, mortalite yüzdelerinin düşmesi bu yöntemin tercih edilmesinin vazgeçilmez nedenleridir. Dalak travmasının yanısıra diğer organ yaralanmalarının olasılığı düşünülmedir.

Keywords

• travma
• çocuklar
• dalak
• tedavi

Retrospective assesment of spleen injuries in children: Ten years of experience in a single center

Abstract

Objective: We aimed to assess the causes of trauma that result in spleen and accompanying organ injuries, management types, and results of management in children referred to our clinic for spleen injuries in the last ten years. Material and Method: The reports of 76 (56 boys,20 girls) patients managed for spleen injuries owing to blunt abdominal trauma between June 2011 and May 2021 were reviewed retrospectively. Results: The patients were aged between 2-17 (8.7±5.4) years old; 56 (73.7%) were boys and 20 (26.3%) were girls. Causes of injuries included accidents involving a motorized vehicle (37,48.7%), falls from height (21, 27.6%), sports/bumping into obstacles (14,18.3%), a crash object in the abdomen (3,3,9%), kick from a horse 1(1.3%). Isolated spleen injury was present in 42 patients (55.3%), while 34 patients (44.7%) had other organ injuries. Spleen injuries were grade I in 9 patients (11.8%), grade II in 18 (23.7.%), grade III in 27 (35.6%), grade IV in 19 (25%), and grade V in 3 (3.9%). Splenectomy was performed in three patients (3.9%) owing to hemodynamic instability and small intestine repair owing to a small intestine injury in two patients (2.6%). None of these patients died from splenic injuries, but one of our patients died from brain injury while in nonoperative treatment. Conclusion: Conservative treatment methods should be chosen in patients with a spleen injury who are hemodynamically stable. The shorter duration of hospital stay, less blood transfusion requirement, and lower morbidity, mortality percentages are indispensable reasons for this method to be preferred. The probability of other organ injuries should be thought of besides splenic trauma.

Keywords

• Trauma
• Children
• Spleen
• Treatment

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