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Tromboemboli ile ortaya çıkan, ateşli silah yaralanmasına sekonder gelişen,femoral arter psödoanevrizma vakası

Year 2018, Volume: 11 Issue: 1, 22 - 24, 01.01.2018

Abstract

Ateşli silah yaralanmaları akut dönemde fatal sonuçlara neden olabildiği gibi geç dönemde de hayati tehdit eden komplikasyonlara da neden olabilir. 34 yaşında erkek hasta ateşli silah yaralanması nedeniyle acil servise başvurdu. Başvuru anında bilinci açık, nabız 140 dk. ve tansiyon 90 /50 mmHg olarak saptandı. Fizik muayenesinde karın ön aksiller çizginin umblikusu kestiği noktadan yaklaşık 2 cm distal, 3 cm lateralinde tek kurşun giriş deliği mevcuttu. Sol spina iliaca anterior superior’un yaklaşık 1 cm üstünden ise çıkış deliği saptandı. Karın ultrasonografisinde yaygın karın içi hemorajik mayi saptanması üzerine acil operasyona alındı. Karın içi eksplorasyonda terminal ileumdan yaklaşık 30 cm distalde, 40 cm’lik ince barsakta lümen ve mezo yaralanması saptandı ve segmenter ince barsak rezeksiyonu uygulandı. Postoperatif 5. günde yoğun bakım izleminde iken sol ayak 4. ve 5. parmakta akut iskemi bulguları saptanması üzerine bilgisayarlı tomografi çekildi. Tomografide sol femoral arterde yaklaşık 3,5 cm çapında femoral arter psödoanevrizması saptanması üzerine ameliyata alındı. Anevrizma rezeke edildikten sonra Gore-tex greft ile rekonstrüksiyon uygulandı. İskemi tablosu gerilemesine karşın sol ayak parmaklarındaki nekrozun düzelmemesi nedeniyle 4. ve 5. parmak amputasyonu yapıldı. Postoperatif izleminde ek sorunla karşılaşılmadan taburcu edildi. Karın içi ateşli silah yaralanması nedeniyle acil cerrahiye alınan hastalarda ek vasküler yaralanmaların olabileceği akılda tutulmalıdır.

The femoral artery pseudoaneurism after gunshot wound presentedwith thromboembolism

Year 2018, Volume: 11 Issue: 1, 22 - 24, 01.01.2018

Abstract

Gunshot wounds could cause fatal consequences in the acute phase as well as life-threatening complications in the late period. A 34-year-old male patient was admitted to emergency services due to gunshot injury. At the time of application, the conscious was open, pulse and blood pressure were detected 140 min. and 90/50 mmHg. On physical examination, there was a single bullet entry hole about 2 cm distal and 3 cm lateral from the umblical cut point of the abdominal anterior axillary line. An exit hole was detected approximately 1 cm above from the left spina iliaca anterior superior. Emergency operation was performed due to extensive intraabdominal hemorr-hagic fluid in abdominal ultrasonography. In the abdominal exploration, intestinal and mesenteric injury were detected and a segmental small bowel resection was performed. On the fifth postoperative day at intensive care unit, the findings of acute ischemic lesions were found out on the left fourth and fifth fingers of leg. A femoral artery pseudoaneurysm was detected in the left femoral artery by CT angio. After the aneurysm was resected, reconstruction with Gore-tex graft was performed. Despite the retraction of the ischemic plate, 4th and 5th finger amputations were performed due to necrosis improvement. In the postoperative follow-up, he was discharged without any additional problems. It should be kept in mind that additional vascular injuries may occur in patients receiving emergency surgery due to intraabdominal gunshot injuries.

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Details

Primary Language Turkish
Subjects Clinical Sciences
Other ID JA82PB53JC
Journal Section Case Report
Authors

Mustafa Özsoy This is me

Zehra Özsoy This is me

Süleyman Şahin This is me

Yüksel Arıkan This is me

Publication Date January 1, 2018
Submission Date January 1, 2018
Published in Issue Year 2018 Volume: 11 Issue: 1

Cite

Vancouver Özsoy M, Özsoy Z, Şahin S, Arıkan Y. Tromboemboli ile ortaya çıkan, ateşli silah yaralanmasına sekonder gelişen,femoral arter psödoanevrizma vakası. JSurgArts. 2018;11(1):22-4.

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