Künt Karın Travması Sonrası Gelişen İzole Jejunum Perforasyonu

Yıl 2019, Cilt: 2 Sayı: 2, 46 - 52, 31.08.2019

Muhammet Akyüz Uğur Topal Şadi İsaoğulları Mustafa Gök

Öz

Künt abdominal travmanın neden olduğu izole
jejunal perforasyon nadirdir ve çoğu kez motorlu taşıt kazalarından sonra ve
yüksekten düşmeler sonrası görülür. Bu yazıda ; acil servise yüksekten düşme
şikayeti ile başvuran ve ilk muayene, radyolojik incelemeleri normal
değerlendirilen künt karın travmalı bir olgunun müşahede altında iken
tekrarlanan fizik muayene ve kontrol görüntülemeleri ile 24 saat sonra tespit
edilen izole jejnum perforasyonu sunulmuştur. 
Künt travmalı hastalarda da izole ince bağırsak yaralanması
olabileceği düşünülerek yapılan tetkik ve muayenelerin normal  olduğu durumlarda bile, tekrarlayan fizik
muayenelerle hastaları takip etme, görüntüleme ve müşahede süresini uzatmanın
önemi büyüktür Bu tür travma
olgularının gözlem altında tutulması  hayati sorunların tespiti için son
derece önemlidir .Erken tanı ve tedavi olası komplikasyonların ve mortalitenin
önlenmesi açısından önemlidir. 

Anahtar Kelimeler

travma, perforasyon, jejenum

Isolated Jejunal perforation following blunt abdominal trauma

Öz

Isolated jejunal perforation caused by blunt abdominal trauma is rare and
most often seen after motor vehicle accidents and falling down from height. In
this article, a case of blunt abdominal trauma which was admitted to the
emergency department with the complaint of falling from the high places is presented. Even though the first physical and radiological examinations
were normal, isolated jejunal perforation was detected in control examinations
and control radiological images while the patient was under observation.
Control examinations, control radiological images and prolonging the
observation time are very important even when the examinations performed with
the idea of isolated small bowel injury in blunt trauma patients are normal.
Keeping such trauma cases under observation is extremely important to detect  life threatening problems. Early diagnosis and treatment is very
important for prevention of possible complications and mortality.

Anahtar Kelimeler

Trauma, perforation, Jejenum

Kaynakça

• 1- Goyal S, Goyal S, Garg MK: Single jejunal blowout perforation following blunt abdominal trauma: Diagnostic dilemma. J Mahatma Gandhi Inst Med Sc, 2013; 18(2): 144–46
• 2- Bas K, Besim H: Delayed diagnosis of isolated jejunal perforation following blunt abdominal trauma. Cumhuriyet Tıp Derg, 2013; 35: 120–233-Victor J. Sorenson, Judy N. Mikhail, Riyad C. Karmy-Jones, Is delayed laparotomy for blunt abdominal trauma a valid quality improvement measure in the era of non-operative management of abdominal injuries? J. Trauma 52 2002; 426–433.
• 4- Griswold RA, Collier HS. Blunt abdominal trauma. Int Abstr Surg 1961;112:309-29
• 5-D.D. Watts, S.M. Fakhry, Incidence of hollow viscus injury in blunt trauma: ananalysis from 275,557 trauma admissions from the EAST multi-institutionaltrial, J. Trauma Inj. Infect. Crit. Care 54 (2)2003; 289–294,
• 6-Sözüer EM, Bedirli A, İkizceli İ, Yeşilkaya Y. Kunt travmaya bağlı izole ince bağırsak yaralanmalarında cerrahi tedavi. Ulusal Travma Dergisi 1997; 3: 298-302.
• 7-Coskun AK, Yarici M, Ulke E, Mentes O, Kozak O, Tufan T. Perforation of isolated jejunum after a blunt trauma: case report and review of the literature. Am J Emerg Med 2007; 25: 862.e1-4.
• 8-A.H. Dauterive, L. Flancbaum, E F Cox. Blunt intestinal trauma, A modern-day review, Ann. Surg. 201 (2) Feb 1985; 198–203.
• 9- J. Pimenta de Castro, G. Gomes, N. Mateus, R. Escrevente, L. Pereira, P. Jácome, Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma—Case report, Int. J. Surg. Case Rep. vol. 7 2015; 51–53
• 10-Al-Ramahi, G., Mohamed, M., Kennedy, K., Sachwani-Daswani, G., McCann, M. Isolated complete jejunal transection following abdominal blunt trauma with delayed presentation. Trauma Case Reports, 2015; 1(5-8), 60-63.
• 11- Allen GS, Moore FA, Cox CS Jr, Wilson JT, Cohn JM, Duke JH. . Hollow visceral injury and blunt trauma. J Trauma 1998;45(1):69-75.
• 12- Pergel, A., Akdoğan, R. A., Aydın, İ. Künt karın travması sonrası gelişen izole jejunum perforasyonu. Dicle Tıp Dergisi,2012; 39(3), 425-427.
• 13- Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt smallbowel perforation. Am J Surg 1994;168:670-5
• 14- Coskun AK, Yarici M, Ulke E, Menteş O, Kozak O, Tufan T. Perforation of isolated jejunum after a blunt trauma: case report and review of the literature. Am J Emerg Med 2007;25:862-e1-e4.
• 15- Fakhry SM, Watts DD, Luchette FA. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from theEAST multi-institutional HVI trial. J Trauma 2003;54(2):295–30
• 16- Fakhry, S. M., Allawi, A., Ferguson, P. L., Michetti, C. P., Newcomb, A. B., Liu, C., Brownstein, M. R. Blunt small bowel perforation (SBP): An Eastern Association for the Surgery of Trauma multicenter update 15 years later. Journal of Trauma and Acute Care Surgery, 2019 ; 86(4), 642-650.
• 17-Evrimler S, Okumuser I, Delibas D. Delayed small bowel perforation with findings of severe ischemia following blunt abdominal trauma. Pol J Radiol. 2017;82:271–4.