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Erişkin Karın Travma Hastalarının ve Karın İçi Solid Organ Yaralanmalarının Değerlendirilmesi

Year 2020, Volume: 2 Issue: 2, 90 - 97, 01.07.2020
https://doi.org/10.38175/phnx.726844

Abstract

Amaç: Çalışmamızda acil serviste karın yaralanması düşünülüp batın tomografisi çekilen erişkin olguların; demografik özelliklerini, karın yaralanmalarının klinik ve laboratuar bulgularını, travmanın şiddetini, mortalite oranlarını, karın içi solid organ yaralanma oranlarını ve organların yaralanma derecelerini incelemeyi ve literatüre katkıda bulunmayı amaçladık.

Yöntem: Bu çalışma acil servise gelen çoklu travma hastalarından batın yaralanması düşünülüp tomografi çekilen 18 yaş üzerindeki 335 hastanın geriye dönük incelenmesi sonucu gerçekleştirildi. Olguların yaşı, cinsiyeti, yaralanma mekanizması, eşlik eden diğer sistem yaralanmaları, vital bulguları, fizik muayene bulguları, laboratuar değerleri, solid organ yaralanma derecesi, olguların yaralanma şiddet skorları, tedavileri ve son durumları kaydedildi. Elde edilen veriler istatistiksel olarak incelendi. 

Bulgular: Olguların % 76.2 erkekti ve hastaların yaş ortalaması 41±18.4 idi. Batın yaralanması şüphesi olan hastaların %92.8’inde künt yaralanma ve %7.2’sinde ise penetran yaralanma tespit edildi. Tüm hastaların mortalite oranı %1.2 tespit edildi. Hastaların % 12.8’inde solid organ yaralanması mevcuttu. Solid organ yaralanması olan hastaların %95.3’ü künt yaralanma idi. Solid organ yaralanması olan olguların %55.8’inde karaciğer, %41.9’sında dalak, %18.6’sında böbrek yaralanması tespit edildi. Solid organ yaralanması tespit edilen hastaların %79.1’i konservatif tedavi edilirken %20.9’una cerrahi tedavi uygulandı. Solid organ yaralanması olan hastaların yaralanma şiddet skorları (ISS ve NISS) ve transaminaz değerleri anlamlı derecede yüksek bulundu (p<0.05). 

Sonuç: Sonuç olarak; karın travma olgularında birden fazla karın içi organın yaralanması, eşlik eden karın dışı yaralanmalar, etkilenen solid organın yaralanma derecesi, yüksek travma indeksi mortalite ve morbiditeyi etkileyen faktörler arasında yer almaktadır.

References

  • 1. French LK, Gordy S, O. John Ma. Abdominal Trauma. In Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM (eds): Emergency Medicine A Comprehensive Study Guide. 8th ed. New York: The Mac Graw Hill Companies, 2015.
  • 2. Isenhour JL, Marx J. Advances in Abdominal Trauma. Emerg Med Clin N Am 2007;25:713-733.
  • 3. Poletti PA, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, Perlmutter D, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma 2004;57:1072-81.
  • 4. Ozkan S. Karın Yaralanmaları. Tüm Yönleriyle Acil Tıp: Tanı, Tedavi ve Uygulama Kitabı. Ed: Zeynep Kekeç. 3. Baskı, Akademisyen Tıp Kitabevi, 2013, s:859-866.
  • 5. Salimi J, Ghodsi M, Zavvarh MN, Khaji A. Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients. Chin J Traumatol. 2009;12:259-62.
  • 6. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective non operative management of penetrating abdominal solid organ injuries. Ann Surg 2006;244:620-8.
  • 7. Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multipleintra-abdominal solid organ injury after blunt abdominal trauma. The Journal of Trauma 2008;4:943-8.
  • 8. Isenhour JL, Marx J. Advances in abdominal trauma. Emerg Med Clin North Am 2007;25:713-33.
  • 9. Butt MU, Zacharias N, Velmahos GC. Penetrating abdominal injuries: management controversies. Scand J Trauma Resusc Emerg Med 2009;17:17-19.
  • 10. Dodiyi-Manuel A, Jebbin NJ, Igwe PO. Abdominal injuries in university of port harcourt teaching hospital. Niger J Surg 2015;21:18-20.
  • 11. Boullion B, Lefering R, Vorveg M, Tiling T, Neugebauer E, Troidl H. Travma score systems: Colognevalidationstudy. J Travma 1997; 42:652-658.
  • 12. Girgin S, Gedik E, Tacyılmaz İH. Kunt karaciğer travmasında uyguladığımız cerrahi yontemlerin değerlendirilmesi. Ulus Travma Acil Cerrahi Derg 2006; 12: 35-42.
  • 13. Karamercan A, Yılmaz TU, Karamercan MA, Aytac B. Blunt abdominal trauma: evaluation of diagnostic options and surgical outcomes. Ulus Travma Acil Cerrahi Derg 2008; 14: 205-10.
  • 14. Taviloğlu K, Günay K, Şahin A, Ertekin C, Türel Ö. Gastrointestinal sistem travmalarına yaklaşım. Ulus. Travma Derg 1995; 2:126-134.
  • 15. Guloğlu R, Yanar H. Karın yaralanmaları. Travma Ed: Ertekin C, Taviloğlu K, Guloğlu R, Kurtoğlu M. Birinci baskı, İstanbul; İstanbul Medikal Yayıncılık; 2005. p. 875-85.
  • 16. Davis JJ, Cohn I, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg 1998; 183 :672.
  • 17. Bilgic I, Gelecek S, Akgun AE, Ozmen MM. Predictive value of liver transaminases levels in abdominal trauma. Am J Emerg Med. 2014;32:705-8.
  • 18. Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma-a 10 years review. World J Emerg Surg 2013;8:14.
  • 19. Koksal O, Ozdemir F, Bulut M, Aydin S, Almacioğlu ML, Ozguc H. Comparison of trauma scoring systems for predicting mortalty in firearm injuries. Ulus Travma Acil Cerrahi Derg 2009; 15: 559-64.
  • 20. Duzgun AP, Ozmen MM, Salyam B, Coşkun F. Factors influencing mortality in traumatic ruptures of diaphragm. Ulus Travma Acil Cerrahi Derg 2008;14: 132-8.
  • 21. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The injury severity scorere visited. J Trauma 1988; 28:69-77.
  • 22. Joseph B, Zangbar B, Pandit V, Kulvatunyou N, Haider A, O'Keeffe T, et al. Mortality after trauma laparotomy in geriatric patients. J SurgRes 2014;190:662-6.
  • 23. Finelli FC, Jonsson J, Champion HR, Morelli S, Fouty WJ. A case control study for major trauma in geriatric patients. J Trauma 1989; 31:1216-26.
  • 24. 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;4:129–134.
  • 25. Nahm NJ, Como JJ, Vallier HA.The impact of majör operative fractures in blunt abdominal injury. J Trauma Acute Care Surg 2013;74:1307-14.
  • 26. Iflazoglu N, Ureyen O, Oner OZ, Tusat M, Akcal MA. Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases. Int J Clin Exp Med 2015;8:6154-62.
  • 27. Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G, Stella F. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multi disciplinary trauma registry. Ann Ital Chir 2010;81:95-102.
  • 28. 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;4:129-34.

Evaluation of Adult Abdominal Trauma Patients and Intra Abdominal Solid Organ Injuries

Year 2020, Volume: 2 Issue: 2, 90 - 97, 01.07.2020
https://doi.org/10.38175/phnx.726844

Abstract

Objectives: In our study, adult patients who underwent abdominal trauma in the emergency department and received abdominal tomography; We aimed to examine demographic features, clinical and laboratory findings of abdominal trauma, severity of trauma, mortality rates, intra-abdominal solid organ injury rates, and degree of injury to organs and contribute to the literature.
Methods: This study was carried out as a result of retrospective examination of 335 patients over the age of 18 who underwent tomography, considering abdominal injury from multiple trauma patients admitted to the emergency department. Age, gender, mechanism of injury, accompanying system injuries, vital signs, physical examination findings, laboratory values, solid organ injury degree, injury severity scores, treatments, and final status of the cases were recorded. The data obtained were analyzed statistically.
Results: 76.2% of the cases were male and the mean age of the patients was 41±18.4 years. Blunt injury was detected in 92.8% and penetrating injury in 7.2% of patients with suspected abdominal injury. The mortality rate of all patients was 1.2%. 12.8% of the patients had solid organ injuries. 95.3% of patients with solid organ injuries were blunt injuries. Liver injury was detected in 55.8%, spleen injury in 41.9% and kidney injury in 18.6% of cases with solid organ injury. While 79.1% of patients with solid organ injuries were treated conservatively, 20.9% were treated surgically. Injury severity scores and transaminase values of patients with solid organ injuries were significantly higher (p <0.05).
Conclusion: As a result; multiple intra-abdominal organ injuries, accompanying extra-abdominal injuries, degree of injury of the affected solid organ, high trauma index are among the factors affecting mortality and morbidity in abdominal injuries.

References

  • 1. French LK, Gordy S, O. John Ma. Abdominal Trauma. In Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM (eds): Emergency Medicine A Comprehensive Study Guide. 8th ed. New York: The Mac Graw Hill Companies, 2015.
  • 2. Isenhour JL, Marx J. Advances in Abdominal Trauma. Emerg Med Clin N Am 2007;25:713-733.
  • 3. Poletti PA, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, Perlmutter D, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma 2004;57:1072-81.
  • 4. Ozkan S. Karın Yaralanmaları. Tüm Yönleriyle Acil Tıp: Tanı, Tedavi ve Uygulama Kitabı. Ed: Zeynep Kekeç. 3. Baskı, Akademisyen Tıp Kitabevi, 2013, s:859-866.
  • 5. Salimi J, Ghodsi M, Zavvarh MN, Khaji A. Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients. Chin J Traumatol. 2009;12:259-62.
  • 6. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective non operative management of penetrating abdominal solid organ injuries. Ann Surg 2006;244:620-8.
  • 7. Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multipleintra-abdominal solid organ injury after blunt abdominal trauma. The Journal of Trauma 2008;4:943-8.
  • 8. Isenhour JL, Marx J. Advances in abdominal trauma. Emerg Med Clin North Am 2007;25:713-33.
  • 9. Butt MU, Zacharias N, Velmahos GC. Penetrating abdominal injuries: management controversies. Scand J Trauma Resusc Emerg Med 2009;17:17-19.
  • 10. Dodiyi-Manuel A, Jebbin NJ, Igwe PO. Abdominal injuries in university of port harcourt teaching hospital. Niger J Surg 2015;21:18-20.
  • 11. Boullion B, Lefering R, Vorveg M, Tiling T, Neugebauer E, Troidl H. Travma score systems: Colognevalidationstudy. J Travma 1997; 42:652-658.
  • 12. Girgin S, Gedik E, Tacyılmaz İH. Kunt karaciğer travmasında uyguladığımız cerrahi yontemlerin değerlendirilmesi. Ulus Travma Acil Cerrahi Derg 2006; 12: 35-42.
  • 13. Karamercan A, Yılmaz TU, Karamercan MA, Aytac B. Blunt abdominal trauma: evaluation of diagnostic options and surgical outcomes. Ulus Travma Acil Cerrahi Derg 2008; 14: 205-10.
  • 14. Taviloğlu K, Günay K, Şahin A, Ertekin C, Türel Ö. Gastrointestinal sistem travmalarına yaklaşım. Ulus. Travma Derg 1995; 2:126-134.
  • 15. Guloğlu R, Yanar H. Karın yaralanmaları. Travma Ed: Ertekin C, Taviloğlu K, Guloğlu R, Kurtoğlu M. Birinci baskı, İstanbul; İstanbul Medikal Yayıncılık; 2005. p. 875-85.
  • 16. Davis JJ, Cohn I, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg 1998; 183 :672.
  • 17. Bilgic I, Gelecek S, Akgun AE, Ozmen MM. Predictive value of liver transaminases levels in abdominal trauma. Am J Emerg Med. 2014;32:705-8.
  • 18. Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma-a 10 years review. World J Emerg Surg 2013;8:14.
  • 19. Koksal O, Ozdemir F, Bulut M, Aydin S, Almacioğlu ML, Ozguc H. Comparison of trauma scoring systems for predicting mortalty in firearm injuries. Ulus Travma Acil Cerrahi Derg 2009; 15: 559-64.
  • 20. Duzgun AP, Ozmen MM, Salyam B, Coşkun F. Factors influencing mortality in traumatic ruptures of diaphragm. Ulus Travma Acil Cerrahi Derg 2008;14: 132-8.
  • 21. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The injury severity scorere visited. J Trauma 1988; 28:69-77.
  • 22. Joseph B, Zangbar B, Pandit V, Kulvatunyou N, Haider A, O'Keeffe T, et al. Mortality after trauma laparotomy in geriatric patients. J SurgRes 2014;190:662-6.
  • 23. Finelli FC, Jonsson J, Champion HR, Morelli S, Fouty WJ. A case control study for major trauma in geriatric patients. J Trauma 1989; 31:1216-26.
  • 24. 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;4:129–134.
  • 25. Nahm NJ, Como JJ, Vallier HA.The impact of majör operative fractures in blunt abdominal injury. J Trauma Acute Care Surg 2013;74:1307-14.
  • 26. Iflazoglu N, Ureyen O, Oner OZ, Tusat M, Akcal MA. Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases. Int J Clin Exp Med 2015;8:6154-62.
  • 27. Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G, Stella F. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multi disciplinary trauma registry. Ann Ital Chir 2010;81:95-102.
  • 28. 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;4:129-34.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Emergency Medicine
Journal Section Research Articles
Authors

Erol Acar This is me 0000-0002-1670-7639

Seda Özkan 0000-0003-1835-8820

Selim Genç This is me 0000-0001-5683-4635

Süleyman Altun 0000-0001-5382-9558

Publication Date July 1, 2020
Submission Date April 25, 2020
Acceptance Date May 11, 2020
Published in Issue Year 2020 Volume: 2 Issue: 2

Cite

Vancouver Acar E, Özkan S, Genç S, Altun S. Erişkin Karın Travma Hastalarının ve Karın İçi Solid Organ Yaralanmalarının Değerlendirilmesi. Phnx Med J. 2020;2(2):90-7.

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