Retrospective assessment of developing liver injuries in children brought to the emergency room due to the blunt abdominal trauma over the past 10 years; a single -center experience.

Year 2021, Volume: 11 Issue: 5, 679 - 684, 17.09.2021

Mehmet Uysal , Ahmet Aslan

https://doi.org/10.16899/jcm.896175

Abstract

OBJECTIVE: In this study it was aimed to evaluate the types of trauma, accompanying solid organ injuries, treatments, and treatment outcomes in children admitted to our clinic in the last 10 years due to blunt liver trauma.
MATERIAL AND METHOD: The data of 47 patients who were involved in liver injuries owing to blunt abdominal trauma between July 2010-May 2020 assessed retrospectively.
RESULTS: There were 30 (63.8%) male, 17 (36.2%) female patients who had carried out with blunt liver injuries between 1-17 (7.8±5.8) years were involved in this study. The induces of these injuries included traffic accidents 29 ( 61.7%), falls from height 12 25.5 %), bicycle accidents 4 (8.5%), objects falling on the body 1(2.1%), and 1(%2.1) after the assault. Twenty-seven (57.4%) of the patients had isolated liver injuries and 20 (42.6%) of other organ injuries.. Liver injuries were 8 patients (17.3%) stage I, 12 patients (26%) stage II, 18 patients (38.2%) stage III, 8 patients (17%) stage IV, 1 patient (2%) stage V. While all patients of stage I and II were treated conservatively, 4 patients (22.2%) who underwent surgery were stage III, 3 patients (37.5%) were stage IV and 1 patient (100%) were stage V. There was an additional ileum perforation in 2 patients in stage III and 1 patient in stage IV who underwent surgery. Thirty-nine patients (83%) were carrıed out by conservatively in these series of liver injury, whereas eight patients (17%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and the number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were particularly lower in surgically conducted patients.
CONCLUSION: Conservative treatment method should be chosen in patients with a liver injury who have stable hemodynamics after blunt trauma. The shorter duration of hospital stay, less blood transfusion requirement, and lower morbidity and mortality rates are important reasons for this method to be preferred.

Keywords

trauma, liver, children, injury

Son 10 yılda künt karın travması nedeniyle acil servise getirilen çocuklarda gelişen karaciğer hasarının geriye dönük değerlendirilmesi; Tek merkez deneyimi.

Abstract

Son 10 yılda künt karın travması nedeniyle acil servise getirilen çocuklarda gelişen karaciğer hasarının geriye dönük değerlendirilmesi; Tek merkez deneyimi.
Mehmet Uysal1,
1Karaman Devlet Hastanesi, Çocuk Cerrahisi Anabilim Dalı, Karaman, Türkiye
AMAÇ: Bu çalışmada son 10 yılda künt karaciğer travması nedeniyle kliniğimize başvuran çocuklarda travma tipleri, eşlik eden solid organ yaralanmaları, tedavileri ve tedavi sonuçlarının değerlendirilmesi amaçlandı.
GEREÇ VE YÖNTEM: Temmuz 2010-Mayıs 2020 tarihleri arasında künt karın travması nedeniyle karaciğer yaralanması nedeniyle tutulan 47 hastanın verileri geriye dönük olarak değerlendirildi.
BULGULAR: Çalışmaya 1-17 (7,8 ± 5,8) yıl arasında künt karaciğer yaralanması ile başvuran 30 (% 63,8) erkek, 17 (% 36,2) kadın hasta dahil edildi. Bu yaralanmaların nedenleri arasında trafik kazaları (29,% 61,7), yüksekten düşme (12,% 25,5), bisiklet kazaları (4,% 8,5), vücuda düşen nesneler (1,% 2,1) ve 1 (% 2,1) ) saldırıdan sonra. Hastaların 27'si (% 57,4) izole karaciğer yaralanması ve 20'si (% 42,6) diğer organ yaralanmaları idi. Karaciğer yaralanmaları 8 hasta (% 17,3) evre I, 12 hasta (% 26) evre II, 18 hasta ( % 38,2) evre III, 8 hasta (% 17) evre IV, 1 hasta (% 2) evre V. Evre I ve II'deki tüm hastalar konservatif olarak tedavi edilirken, cerrahi uygulanan 4 hasta (% 22,2) evre III, 3 hastalar (% 37,5) evre IV ve 1 hasta (% 100) evre V idi. Evre III' te 2, evre IV'te ameliyat edilen 1 hastada ek ileum perforasyonu vardı. Bu karaciğer hasarı serilerinde otuz dokuz hasta (% 83) konservatif olarak tedavi edilirken, vital bulguları stabil olmayan 8 (% 17) hastaya ameliyat yapıldı. Cerrahi tedavi gören hastalarda ölüm oranı, yoğun bakım ve hastanede kalış süresi ve kan transfüzyonu sayısı daha yüksek iken, hemoglobin düzeyi ve kan basıncı cerrahi olarak uygulanan hastalarda özellikle daha düşüktü.
SONUÇ: Künt travma sonrası hemodinamisi stabil olan karaciğer yaralanmalı hastalarda konservatif tedavi yöntemi seçilmelidir. Hastanede kalış süresinin daha kısa sürmesi, daha az kan transfüzyonu gerektirmesi ve daha düşük morbidite, mortalite yüzdeleri bu yöntemin önemli tercih sebebidir.

Keywords

travma,, karaciğer, çocuklar, yaralanma

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