MANAGEMENT OF CONCURRENT ABDOMINAL INJURIES IN PATIENTS WHO UNDERWENT THORACOSTOMY/THORACOTOMY SECONDARY TO TRAUMA

Abstract

Objective To contribute to the literature by sharing the treatment approach and results of thoracoabdominal injuries with a thorax abbreviated injury scale score of 2 or above. Materials and Methods The study was carried out retrospectively at Yozgat City Hospital between January 2017 and December 2020. Patients who underwent tube thoracostomy or thoracotomy after trauma were identified. Subsequently, patients older than 18 years of age with concurrent abdominal organ injury and diaphragmatic injury were identified. The demographic characteristics, laboratory values, imaging reports, treatment methods, and perioperative data were obtained from the electronic recorded patient information of the hospital. Results Thoracoabdominal injuries were detected in 23 (19.3%) of 119 patients with a thorax abbreviated injury scale score of 2 or above. In thoracoabdominal injuries, 19 (82.6%) of the attempts to the thorax comprised tube thoracostomy, and 4 (17.4%) thoracotomy. Thoracotomy was not indicated in any of the patients who had a tube inserted at the beginning, and tube thoracostomy was a sufficient treatment. The laparotomy rate of all thoracoabdominal traumas was 44.8%. Surgical treatment was significantly more preferred in penetrating injuries. Spleen (35%) and liver (32.5%) were the most frequently injured organs, respectively. Solid organ injuries comprised 74.2% of the total injured organs, and conservative treatment was applied in 76% of these cases. Surgical treatment was performed in all diaphragm and hollow organ injuries. Death occurred in two patients (8.7%) in total and these cases were patients who underwent thoracotomy. Conclusion Management of thoracoabdominal trauma vary depending on the source of the trauma, the hospital's equipment, and the surgeon's experience. Thoracotomy and laparotomy rates are higher in penetrating injuries. Tube thoracostomy and conservative treatment are usually sufficient in blunt traumas and can be successfully applied in secondary service hospitals.

Keywords

• Trauma
• Abdominal injury
• Tube thoracostomy
• Thoracotomy

TRAVMAYA SEKONDER TÜP TORAKOSTOMİ/ TORAKOTOMİ UYGULANAN HASTALARDA EŞ ZAMANLI GÖRÜLEN KARIN YARALANMALARI VE YÖNETİMİ

Abstract

Amaç Toraks abbreviated injury scale skoru 2 ve üzeri torakoabdominal yaralanmalarda uygulanan tedavi yaklaşımı ve sonuçlarını paylaşarak literatüre katkı sunmak. Gereç ve Yöntem Çalışma Ocak 2017-Aralık 2020 tarihleri arasında Yozgat Şehir Hastanesi’nde retrospektif olarak gerçekleştirildi. Travma sonrası tüp torakostomi veya torakotomi yapılmış hastalar tespit edildi. Ardından eş zamanlı karın organ yaralanması ve diyafragma yaralanması olan 18 yaşından büyük hastalar belirlendi. Hastaların demografik özellikleri, labaratuvar değerleri, görüntüleme raporları, uygulanan tedavi yöntemleri, perioperatif verileri hastane elektronik kayıtlı hasta bilgilerinden elde edildi. Bulgular Toraks abbreviated injury scale skoru 2 ve üzeri olan toplam 119 hastanın 23’ünde (% 19,3) torakoabdominal yaralanma saptandı. Torakoabdominal yaralanmalarda toraksa yönelik girişimlerin 19’unu (% 82,6) tüp torakostomi ve 4’ünü (% 17,4) torakotomi oluşturuyordu. Başlangıçta tüp takılan hiçbir hastada torakotomi endikasyonu oluşmadı ve tüp torakostomi yeterli bir tedavi oldu. Tüm torakoabdominal travmaların laparotomi oranı ise % 44,8 ’idi. Cerrahi tedavinin anlamlı bir şekilde penetran yaralanmalarda daha sık tercih edildiği görüldü. Dalak (% 35) ve karaciğer (% 32,5) sırasıyla en sık yaralanan organlardı. Solid organ yaralanmaları toplam yaralanan organların % 74,2’ini oluşturuyordu ve bunların % 76’sında konservatif tedavi uygulandı. Diafragma ve içi boş organ yaralanmalarının tamamında cerrahi tedavi yapıldı. Toplam iki hastada (% 8,7) ölüm görüldü ve bu vakalar torakotomi uygulanan hastalardı. Sonuç Torakoabdominal travmaların yönetimi travmanın kaynağına, hastanenin donanımına ve cerrahın deneyimine göre değişebilir. Penetran yaralanmalarda torakotomi ve laparotomi oranları daha yüksektir. Künt yaralanmalarda tüp torakostomi ve konservatif tedavi genellikle yeterli olmaktadır ve ikinci basamak bir hizmet hastanesinde de başarıyla uygulanabilir.

Keywords

• Travma
• Karın yaralanması
• Tüp torakostomi
• Torakotomi

References

1. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. Journal of Trauma and Acute Care Surgery. 2006;60(6):S3-S11.
2. Trajano AD, Pereira BM, Fraga GP. Epidemiology of in-hospital trauma deaths in a Brazilian university hospital. BMC emergency medicine. 2014;14(1):22.
3. Pfeifer R, Tarkin IS, Rocos B, Pape H-C. Patterns of mortality and causes of death in polytrauma patients—has anything changed? Injury. 2009;40(9):907-11.
4. Broska Júnıor Ca, Botelho Ab, Lınhares Adc, De-Olıverıa Ms, Veronese G, Naufel Júnıor Cr, et al. Perfil dos pacientes vítimas de trauma torácico submetidos à drenagem de tórax. Revista do Colégio Brasileiro de Cirurgiões. 2017;44(1):27-32.
5. Molnar TF. Thoracic trauma: which chest tube when and where? Thoracic surgery clinics. 2017;27(1):13-23.
6. Kong V, Oosthuizen G, Clarke D. Selective conservatism in the management of thoracic trauma remains appropriate in the 21st century. The Annals of The Royal College of Surgeons of England. 2015;97(3):224-8.
7. Bayer J, Lefering R, Reinhardt S, Kühle J, Südkamp NP, Hammer T, et al. Severity-dependent differences in early management of thoracic trauma in severely injured patients-Analysis based on the TraumaRegister DGU®. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2017;25(1):10.
8. Yang F, Bai XJ, Li ZF. Analysis of misdiagnosis in patients with multiple trauma. Chinese journal of traumatology = Zhonghua chuang shang za zhi. 2011;14(1):20-4.

9. Ferrah N, Cameron P, Gabbe B, Fitzgerald M, Martin K, Beck B. Trends in the nature and management of serious abdominal trauma. World journal of surgery. 2019;43(5):1216-25.
10. Moore E, Shackford S, Pachter H, McAninch J, Browner B, Champion H, et al. Organ injury scaling: spleen, liver, and kidney. The Journal of trauma. 1989;29(12):1664-6.
11. Moore E, Cogbill T, Malangoni M, Jurkovich G, Champion H, Gennarelli T, et al. Organ injury scaling, 11: Pancreas, duodenum, small bowel, colon, and rectum. Journal of Trauma and Acute Care Surgery. 1990;30(11):1427.
12. Bertoglio P, Guerrera F, Viti A, Terzi AC, Ruffini E, Lyberis P, et al. Chest drain and thoracotomy for chest trauma. Journal of Thoracic Disease. 2019;11(Suppl 2):S186.
13. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Annals of surgery. 2006;244(4):620-8.
14. Kulshrestha P, Munshi I, Wait R. Profile of chest trauma in a level I trauma center. J Trauma. 2004;57(3):576-81.
15. Demirhan R, Onan B, Oz K, Halezeroglu S. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interactive cardiovascular and thoracic surgery. 2009;9(3):450-3.
16. Harrell KN, Brooks DE, Palm PH, Cowart JT, Maxwell R, Barker D. A Comparison of Prehospital Nonphysician and Hospital Physician Placed Tube Thoracostomy. SAGE Publications Sage CA: Los Angeles, CA; 2020.
17. Demetriades D, Rabinowitz B, Markides N. Indications for thoracotomy in stab injuries of the chest: a prospective study of 543 patients. The British journal of surgery. 1986;73(11):888-90.
18. Edelman DA, White MT, Tyburski JG, Wilson RF. Factors affecting prognosis in patients with gastric trauma. The American surgeon. 2007;73(1):48-53.
19. Watts DD, Fakhry SM. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial. J Trauma. 2003;54(2):289-94.
20. Gao JM, Du DY, Li H, Liu CP, Liang SY, Xiao Q, et al. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: Difference between penetrating and blunt injuries. Chinese journal of traumatology = Zhonghua chuang shang za zhi. 2015;18(1):21-6.
21. Stawicki SP. Trends in nonoperative management of traumatic injuries - A synopsis. International journal of critical illness and injury science. 2017;7(1):38-57.
22. Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010;68(3):721-33.
23. Coleman JJ, Zarzaur BL. Surgical Management of Abdominal Trauma: Hollow Viscus Injury. The Surgical clinics of North America. 2017;97(5):1107-17.
24. Goin G, Massalou D, Bege T, Contargyris C, Avaro JP, Pauleau G, et al. Feasibility of selective non-operative management for penetrating abdominal trauma in France. Journal of visceral surgery. 2017;154(3):167-74.
25. Fodor M, Primavesi F, Morell-Hofert D, Kranebitter V, Palaver A, Braunwarth E, et al. Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years. World Journal of Emergency Surgery. 2019;14(1):29.
26. Bjurlin MA, Fantus RJ, Fantus RJ, Villines D. Comparison of nonoperative and surgical management of renal trauma: Can we predict when nonoperative management fails? The journal of trauma and acute care surgery. 2017;82(2):356-61.
27. Cimbanassi S, Chiara O, Leppaniemi A, Henry S, Scalea TM, Shanmuganathan K, et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference. The journal of trauma and acute care surgery. 2018;84(3):517-31.
28. Baygeldi S, Karakose O, Özcelik KC, Pülat H, Damar S, Eken H, et al. Factors Affecting Morbidity in Solid Organ Injuries. Disease Markers. 2016;2016:6954758.
29. Reddy NB, Hanumantha, Madithati P, Reddy NN, Reddy CS. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study. Journal of emergencies, trauma, and shock. 2014;7(2):116-20.
30. Murray JA, Berne J, Asensio JA. Penetrating thoracoabdominal trauma. Emergency medicine clinics of North America. 1998;16(1):107-28.