Üçüncü Basamak Merkeze Ait Acil Genel Cerrahi Deneyimi

Yıl 2022, Cilt: 19 Sayı: 1, 38 - 43, 28.04.2022

İlhan Taş , Ebral Yiğit

https://doi.org/10.35440/hutfd.1067676

Öz

Amaç: Bu çalışmada “Hastanemizin acil genel cerrahi hizmet kalitesini nasıl artırabiliriz?” sorusuna cevap aramayı amaçladık.
Material ve Metod: Bu retrospektif çalışma Ocak 2016 – Ocak 2020 tarihleri arasında Gazi Yaşargil Eğitim Araştırma Hastanesi Genel Cerrahi kliniğinde gerçekleştirildi. Acil servise başvuran ve Genel Cerrahi kliniğince acil operasyona alınan hastalar çalışmaya dahil edildi. Hastaların cinsiyet, yaş, anamnez, laboratuar tetkikleri, radyolojik bulguları, preoperatif tanıları, ameliyat notları ve postopertatif sonuçları kaydedildi.
Bulgular: Bu çalışmaya alınan toplam hasta sayısı 2820 idi. Bunların 1201’i (%42,6) kadın, 1619’u (%57,4) erkek idi. Hastaların ortalama yaşı 37,32 yıl ( min:14, max:94 ) idi. En sık karşılaşılan yaş aralığı 21-30 yaş aralığı idi.
Acil operasyonların çoğunu 2645 (%93,8) hasta ile nontravmatik nedenler oluşturuyordu. Bunların 1790’ ı (%67,67) appendisit idi. Diğer nontravmatik acil operasyon nedenleri; apse, inkarsere herni, ileus ve perforasyon idi.
Genel cerrahi acilimize gelen 175 (%6,2) hasta travma nedeniyle opere edildi. Hastalarda travmanın en yaygın nedenleri %43,4 ile kesici ve delici alet yaralanması (KDAY) ve %39,4 ile ateşli silah yaralanmaları (ASY) idi.
Sonuç: Hastanelerin bulunduğu bölgeye göre acil olguların sıklık ve dağılımı değişmektedir. Acil cerrahi ile ilgili epidemiyolojik çalışmalar ve verilerin artması bölgelerin acil cerrahi profilinin belirlenmesine ve hastane çalışanlarının gelebilecek hastalara hazırlıklı olmasına imkân sağlar.

Anahtar Kelimeler

Akut karın, travmatik akut karınlar, nontravmatik akut karınlar

Destekleyen Kurum

yok

Emergency General Surgery Experience Of A Tertiary Center

Öz

Background: We aimed to present the emergency General Surgery patient profile and results of our hospital.
Materials and Methods: This retrospective study was conducted in Diyarbakır Gazi Yaşargil Training and Research Hospital Clinic between 1 January 2016 and 31 December 2019. Patients who were admitted to the emergency department and underwent emergency operations at the General Surgery clinic were included in the study. Gender, age, anamnesis, laboratory tests, radiological findings, preoperative diagnoses, surgery notes, and postoperative results of the patients were recorded.
Results: A total number of 2820 cases including 1201 (42.6%) female, and 1619 (57.4%) male patients were enrolled in the study. The mean age of the patients was 37.32 years (min: 14, max: 94). The most common age range was between the ages of 21-30 years.
Most of the emergency surgeries were performed due to nontraumatic indications in 2645 (93.8%) , and 1790 of them (67.67%) were cases of appendicitis. Other indications of nontrau-matic emergency surgeries were abscess, incarcerated hernia, ileus, and perforation. 175 (6.2%) patients who came to our general surgery emergency department were operated on due to trauma. The most common causes of trauma in these patients were sharp force and stab in-juries in 43.4% and gunshot wounds in 39.4% of the cases.
Conclusions: The frequency and distribution of emergency cases vary according to the locations of the hospitals. Epidemiological studies and increasing data on emergency surgery enable the determination of the emergency surgery profile of the regions and the preparation of the hos-pital staff for the patients who will seek medical help.

Anahtar Kelimeler

Acute abdomen, Traumatic acute abdomen, Nontraumatic acute abdomen, Acute abdomen, Traumatic acute abdomen, Nontraumatic acute abdomen

Kaynakça

• 1. Aydın O. Acil servisten genel cerrahiye konsülte edilen olguları tanısal analizi. KÜ Tıp Fak Derg 2014;16(3):1-3.
• 2. Jawaid M, Raza SM, Alam SN, Manzar S. On-call emergency work load of a general surgical team. Journal of Emergencies. Trauma and Shock 2009;2(1):10-5.
• 3. Turan M, Şen M, Koyuncu A, Aydın C, Karadayı K, Canbay E. Yeni gelişmeler ışığında akut karın. C.Ü. Tıp Fakültesi Dergisi 2002;24(1):45-52.
• 4. Grundmann RT, Petersen M, Lippert H, Meyer F. Theacute (surgical) abdomen-epidemiology, diagnosis and general principles of management. Z Gastroenterol 2010;48(6):696-706.
• 5. Hatipoğlu RA, Karagülle E, Karakaya K, Gökçe SF, Abcı I. Dokuz yıllık travma olgularımız. Ulus Travma Acil Cerrahi Derg 2001;7(2):91-5.
• 6. Rosen MP, Sands DZ, Longmaid HE, Reynolds KF, Wagner M, Raptopoulos V. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. Am J Roentgenol 2000;174:1391-6.
• 7. Lameris W, Randen A, Dijkdraaf M, Bossuyt P, Stoker J, Boermeester M. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and raionale. BMC Emergency Medicine 2007;7:9.
• 8. Saleh MA, Troy S, Etienne T. What Clinical and Laboratory Parameters Determine Significant intra-abdominal Pathology for Patients Assessed in Hospital with Acute Abdominal Pain? World J Emerg Surg. 2007;2:26. [PMC free article] [PubMed] [Google Scholar]
• 9. Muhammad TA, Asma H, Waqar SH, Shah SF, Zafar IM, Zahid MA. Presentation and Outcome of Acute Abdomen in a Tertiary Care Unit. Ann Pak Inst Med Sci. 2011;7:137–44. [Google Scholar]
• 10. Ohene-Yeboah M. Acute surgical admissions for abdominal pain in adults in Kumasi, Ghana. ANZ J Surg. 2006;76:898–903. [PubMed] [Google Scholar]
• 11. Caterino S, Cavallini M, Meli C, Murante G, Schiffino L, Lotito S, et al. Acute abdominal pain in emergency surgery. Clinical epidemiologic study of 450 patients. Ann Ital Chir. 1997;68:807–17. [PubMed] [Google Scholar]
• 12. Ertekin C, Güloğlu R, Taviloğlu K. Akut Karın Hastasına Yaklaşım: Acil Cerrahi. Nobel tıp kitabevi; 2009. s.257-77.
• 13. Menteş Ö, Eryılmaz M, Yiğit T, Taşçı S, Balkan M, Kozak O, et al. 60 yaş üstü apendektomili olgularımızın retrospektif analizi. Akademik Acil Tıp Dergisi 2008;7:36-41.
• 14. Kulkarni S, Kanase V, Kanase N, Varute P. Blunt Trauma to abdomen in rural setup: a multiple case study. Intern J Sci Study. 2015;3(4):16-9.
• 15.Kala SK, Mathur RK, Singh SP. A clinical study of blunt abdomen trauma. Intern J Recent Trends Sci Technol. 2015;15(3):626-30.
• 16. Mukhopadhyay M. intestinal injury from blunt abdominal trauma: a study of 47 cases. Oman Med J. 2009;24(4):256-9
• 17.Musau P, Jani PG, Owillah FA. Pattern and outcome of abdominal injuries at Kenyatta National Hospital, Nairobi. East African Med J. 2006;83(1):37-43.
• 18. Gad MA, Saber A, Shams M, Farrag S, Ellabban G. Incidence, patterns and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4(3):129-34.
• 19. Mehta N, Babu S, Venugopal K. An experience with blunt abdominal trauma: evaluation, management and outcome. Clinics and Practice. 2014;4(599):35-7.
• 20.Manohar K, Ramanaiah GV. Abdominal Trauma in adults- its outcome- a prospective study in a teritiary health care centre in Andhra Pradesh. Indian J Appl Res. 2015;5(11):35-8
• 21. Wani, M., Chalkoo, M., Makhdoomi, P.H.A., Banotra, A., Mueed, A., Arafat, Y. and Shakeeb, S. (2017) An Analysis of War Weaponry Trauma Victims from a Medical College Setting in Kashmir Valley. Surgical Science , 8, 9-18
• 22. Srihari V, Vanraden M, Angeles L. A Clinical study of blunt injury abdomen. Indian J Res. 2015;(1):123-6.
• 23.Awe JAA, Am S. Abdominal trauma: a five year experience in a military hospital. Glo Adv Res J Med Med Sci. 2013;2(8):177-83.
• 24. Asuquo M, Nwagbara V, Umoh M, Ugare G, Agbor C, Japhet E et al. Blunt abdominal trauma in a teaching hospital, Calabar, Nigeria. Int J Clin Med. 2012;3(7):693-6.
• 25.Gopalswamy S, Mohanraj R, Viswanathan P, Baskaran V. Non-operative management of solid organ injuries due to blunt abdominal trauma (NOMAT): seven-year experience in a teaching district general hospital. A prospective study. The Internet Journal of Surgery. 2008;15(2).
• 26. Zarour A, El-Menyar A, Khattabi M, Tayyem R, Hamed O, Mahmood I et al. A novel practical scoring for early diagnosis of traumatic bowel injury without obvious solid organ injury in hemodynamically stable patients. Int J Surg. 2014;12(4):340-5
• 27.Ahmet Kocakuşak, Ahmet Fikret Yücel, Soykan Arıkan, Karına Nafiz Delici - Kesici Alet Yaralanmalarında Rutin Abdominal Eksplorasyon Yönteminin Retrospektif Analizi, Van Tıp Dergisi: 13 (3):90-96,2006
• 28. Idriss, A.M., Tfeil, Y., Baba, J.S., Boukhary, S.M., Hamad, B., Abdllatif, M., Kane, T.A., Abdllahi, M., Moctar, B. and Taleb, B. (2018) Abdominal Trauma: Five Years Experience in National Centre Hospital, Mauritania. Open Journal of Emergency Medicine , 6, 6-14. https://doi.org/10.4236/ojem.2018.61002
• 29. Khan Muhammad Babar, Humera Sadaf Bugti, Fida Ahmed Baloch, Shakeel Akbar, Abdullah Makki, Bilal Elahi, patterns and outcome of penetrating abdominal trauma ,The Professional Medical Journal DOI: 10.29309/TPMJ/2019.26.07.3768
• 30. Audumbar N. Maske, Santoshkumar N. Deshmukh, Traumatic abdominal injuries: our experience at rural tertiary care center International Surgery Journal Maske AN et al. Int Surg J. 2016 May;3(2):543-548