PENETRATING INJURIES OF THE STOMACH AND ESOPHAGUS

Between the years 1990 and 1995, 521 patients underwent surgery secondary to penetrating abdominal trauma. Of 94 patients (18%) who had sustained injuries to the stomach and esophagus were evaluated according to the etiology of the trauma, associated organ injury, principles of treatment, penetrating abdominal trauma index (PATI), morbidity and mortality rates. Seventy four of patients were male and 20 female with a median age of 33.5. The mechanism of the injuries were stab wounds (in 26 of the patients) and gunshot wound (in 68 of cases) with rates of 27.7% and 72.3% respectively. There were 3 esophageal (3.3%), 89 gastric (94.7%) and 2 combine (2.1%) injuries. Only nine patients (9.6%) had isolated gastric injury while in 85 of them (90.4%) there were associated injured intraabdominal organs. Primary repair was performed in 5 of the esaphageal (100%) and 88 of the gastric (96.7%) injuries. Three patients (3.3%) underwent distal gastric resection and gastroenterostomy because of the extent of the injury. There were no morbidity directly related with the repair of these two organs, but were 8 major (8.5%) complications secondary to the associated injuries. 15(15.9%) cases-eight of them intraoperatively who died-had a mean PATI of 46.4 (ranged 6-97). As a result most of the esophageal and gastric injuries-except the ones with vide loss of tissue - can be repaired quickly by primary repair with safety. Morbidity and mortality cause are belong to the associated organ injuries.

PENETRAN MÝDE VE ÖZOFAGUS YARALANMALARI

1990 ile 1995 tarihleri arasýnda penetran abdominal travma nedeni ile opere edilen 521 olgudan, mide ve özofagus yaralanmasý saptanan 94(%18) olgu travma etkeni, yandaþ organ yaralanmasý, tedavi yöntemleri, Penetran Abdominal Travma Ýndeksi (PATÝ), morbidite ve mortalite açýsýndan deðerlendirildi. Olgularýmýzýn 74'ü erkek, 20'si kadýn olup, yaþ ortalamasý 33.5 idi. Travma etkeni 26 (%27.7) olguda kesici-delici aletler (KDAY), 68 (%72.3) olguda ateþli silahlardý (ASY). 3 (%3.3) olguda özofagus, 2 (%2.1) olguda özofagus + mide ve 89(%94.7) olguda mide yaralanmasý saptandý. Olgularýn 9 (%9.6)'unda izole mide yaralanmasý görülürken, 85(%90.4) olguda yandaþ intraabdominal organ yaralanmasý okluðu görüldü. Özofagus yaralanmasý olan 5 (%100) ve mide yaralanmasý olan 91 olgudan 88(%96.7)'ine primer sütürle onarým yapýldý. 3 (%3.3) olguda geniþ doku kaybý nedeniyle distal mide rezeksiyonu + gastroenterostomi yapýldý. Olgularýn hiçbirinde özofagus ve mideye yapýlan operasyon ile direkt iliþkili olarak komplikasyon geliþmezken, yandaþ organ yaralanmalarý ile iliþkili olarak 8 (%8.5) olguda majör komplikasyon geliþtiði belirlendi. 8 (%8.5) olgu intraoperatif olmak üzere toplam 15 (%15.9) olgu kaybedildi. Kaybedilen olgularda PATÝ'nin, 6 ile 97 arasýnda olduðu ve ortalama deðerin 46.4 olduðu görüldü. Sonuçlarýmýz, geniþ doku kaybýna neden olmayan mide ve özofagus yaralanmalarýnýn primer sütür yöntemiyle hýzlý ve güvenle onarýlabileceðini, morbidite-mortalitenin daha çok yandaþ organ yaralanmalarýna baðlý olduðunu göstermektedir.