Penetrating stab wounds to the abdomen: Results in our secondary care center

Öz

INTRODUCTION: Criminal incidents in cities receiving internal and external immigration can be more frequent than in other cities. As we are working in such a city, we frequently encounter trauma patients in the emergency room. The aim of this study was to scrutinize the outcomes of penetrating stab wounds to the abdomen and discuss the results achieved in our hospital, a secondary care center, in comparison with studies in the literature. METHODS: Files in the electronic data bank of patients who presented to our emergency room with stab wounds were examined. Those treated in the emergency room with simple medical intervention, patients with no penetrating wound to the abdomen, and patients younger than 18 years old were excluded from the study. Gender, age, location and type of wound, vital signs, laboratory parameters, radiological examinations, and pre- and postoperative results of 284 patients who underwent laparotomy were recorded. RESULTS: Laparotomy was performed on 284 patients included in the study. The procedure was prescribed in 12 patients for positive findings requiring peritoneal lavage, in 44 patients for findings of severe peritonitis, in 112 patients for wound exploration, in 36 patients for omental or organ evisceration, in 32 patients for shock or disruption of vital signs, and in 48 patients due to organ injury and/ or generalized fluid detected in CT. While organ injury was present in 110 of 284 patients, 174 patients underwent negative laparotomy 102 and non-therapeutic surgical procedure 72 . CONCLUSION: The rate of negative and non-therapeutic laparotomy was 61.26%. This is higher than in other studies in the literature. The reason may be problems related to the institution being a secondary care center or that surgeons decided to perform laparotomy more frequently due to increased medico-legal concerns.

Anahtar Kelimeler

• Stab wounds
• penetrating wound to abdomen
• negative laparotomy
• unnecessary laparotomy

Batına nafiz delici kesici alet yaralanmaları: İkinci basamak sağlık merkezi olan hastanemizin sonuçları

Öz

AMAÇ: Sürekli iç ve dış göç alan şehirlerde kriminal olaylar diğer şehirlere göre daha sık olabilir.Bu özellikleri taşıyan bir kentte çalışıyoruz dolayısıyla acil serviste sıkça travma hastalarıyla karşılaşıyoruz.Bu çalışmada batına nafiz delici-kesici alet yaralanmalarının sonuçlarını irdelemek ve ikinci basamak sağlık merkezi olan hastanemizin sonuçlarını literatür eşliğinde tartışmayı amaçladık. YÖNTEM: Hastanemizin acil servisine delici- kesici alet yaralanması nedeniyle başvuran hastaların dosyaları elektronik veri bankası kullanılarak incelendi. Basit tıbbi müdahale ile acilde tedavi edilenlerle batına nafiz olmayan hastalar ve 18 yaş altı hastalar çalışmaya alınmadı. Laparotomi yapılan 284 hastanın cinsiyeti,yaşı, yaralanma şekli,lokalizasyonu, vital bulguları, laboratuvar parametreleri,radyolojik tetkikleri, ameliyat öncesi ve ameliyat sonrasındaki bulgular kaydedildi. BULGULAR: Çalışmaya alınan 284 hastaya laparotomi yapıldı. Laparotomi kararı 12 hastada peritoneal lavaj pozitif olduğunda,44 hastada ciddi pertonit bulguları olduğunda,112 hastaya yara eksprolasyonu sonucunda,36 hastada omentum veya organ eviserasyonu olduğunda,32 hastada şok veya vital bulgularının stabilitesinin bozulmasından dolayı ve 48 hastada bilgisayarlı tomografide organ yaralanması ve/veya yaygın sıvı tespit edildiğinde laparotomi yapıldı.Ameliyat edilen 284 hastanın 110 unda organ yaralanması olmasına rağmen 174 hasta da negatif laparotomi 102 ve nonterapötik 72 cerrahi işlem yapıldı. SONUÇ: Çalışmamızda negatif laparotomi ve nonterapotik laparotomi oranımız %61.26 idi. Bu oran literatürdeki çalışmalara göre fazlaydı.Bundan ikinci basamak bir sağlık merkezi oluşumuzdan kaynaklanan problemlerin olabileceği ve artan medikolegal sorunlardan dolayı cerrahların laparotomi kararını daha sık almalarının etkili olduğunun sonucuna vardık.

Anahtar Kelimeler

• Delici-kesici alet yaralanması
• batına nafiz yaralanma
• negatif laparotomi
• gereksiz laparotomi

Kaynakça

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