Ateþli silah yaralanmasý olgularýnýn ameliyat sonrasý takibinde bilgisayarlý tomografi endikasyonlarý ve bilgisayarlý tomografi raporlarýnýn kliniðe yararlýlýðý açýsýndan deðerlendirilmesi

AMAÇ: Çalýþmamýzda ateþli silah yaralanmalarý (ASY) nedeniyle tersiyer merkezimizde takip ve tedavisi yapýlan hastalarýn alt toraks tomografisi (ATT) ve üst batýn tomografi (ÜBT) sonuçlarýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmamýz geriye dönük tanýmlayýcý bir çalýþma olarak planlandý. Ocak 2016–Nisan 2020 tarihleri arasýnda ASY nedeniyle kliniðimizde yatýþý yapýlan hastalar geriye dönük olarak analiz edildi. Ameliyat sonrasý alt toraks ve üst batýn tomografileri çekilen 44 hasta deðerlendirmeye alýndý.
BULGULAR: Hastalarýn 43’ü (%97.72) erkek 1’i (%2.27) kadýn, yaþ ortalamasý 27.45 (daðýlým, 20–53) idi. Hastanede kalýþ süreleri ortalama 14.93 (daðýlým, 5–38) gündü. Çekilen tomografi sayýsý ortalama 1.65 (daðýlým, 1–4) olup Injuriy Severity Score (ISS) ortalama 24.38 (daðýlým, 12–43) idi. Hastalarýn 31’i (%70.45) tabanca ya da tüfek gibi doðrudan ASY’ye maruz kalýrken, 13’ü (%29.5) bomba patlamasý sonucu ortama daðýlan þarapnel parçalarý ile sekonder olarak yaralandý. Ýlk operasyonlarý dýþ merkezde yapýlan 23 (%52.27) hastaya klinik izlem yapýldý, 15 (%34.09) hasta ilk kez ameliyat edildi, 6 (%13.63) hasta ise 2. kez ameliyat edildi. ATT; 25 (%56.81) hastada solunum sýkýntýsý nedeniyle,13 (%29.54) hastada dogrudan toraks travmasý nedeniyle, 6 (%13.63) hastada ise batýn tomografisine ek olarak kontrol amaçlý çekildi. ÜBT ise 29( %65.90) hastada ameliyat sonrasý kontrol amaçlý, 12 (%27.27) hastada ameliyat öncesi deðerlendirme amaçlý, 3 (%6.81) hastada ise doðrudan batýn travmasý olmadan, blastik travmanýn etkilerini deðerlendirmek için çekildi. ATT’de en sýk gözlenen bulgu efüzyon (%47.7) idi. ÜBT’nin %61.36’sýnda patoloji gözlenmezken, %20.45’inde karaciðer lasersayonu gözlendi. ATT ve ÜBT’nin toplam maliyeti tüm toraks ve batýn tomografisinin toplam maliyetinin yaklaþýk yarýsý kadardý.
TARTIÞMA: Ateþli silah yaralanmasý sonrasýnda çekilen selektif alt toraks ve üst batýn tomografileri sadece patolojiyi saptamada deðil ameliyat sonrasý takipte de etkili, hýzlý, güvenilir, kost efektif bir görüntüleme yöntemi olarak kullanýlabilir.

Assessment of computed tomography indications and computed tomography reports for usefulness in clinical presentation at postoperative follow-up of gunshot wound cases

BACKGROUND: The present study aimed to evaluate the results of lower thoracic tomography (LTT) and upper abdominal tomography (UAT) of the patients who were treated and followed at our tertiary center due to gunshot wounds (GSWs).
METHODS: The present research was designed as a retrospective descriptive study. All patients, who were admitted to our clinic due to GSW between January 2016 and April 2020, were retrospectively analyzed. This study included 44 patients who had postoperative lower thoracic and upper abdominal tomography scans.
RESULTS: Among the patients, 43 (97.72%) were male, and one (2.27%) patient was female, with a mean age of 27.45 (range: 20–53) years. The mean length of hospital stay was 14.93 (range: 5–38) days. The mean number of tomography scans per patient was 1.65 (1–4), and the mean Injury Severity Score (ISS) was 24.38 (12–43). Among the patients, 31 (70.45%) had a direct GSW from a pistol or a rifle, while 13 (29.5%) sustained secondary injuries from shrapnel emanating from a bomb explosion. Furthermore, 23 (52.27%) patients who were initially operated at another center were clinically observed, while 15 (34.09%) patients were operated for the first time, and six (13.63%) patients had their second operation. LTT scans were obtained due to dyspnea, direct thoracic trauma and in addition to abdominal tomography for follow-up in 25 (56.81%), 13 (29.54%) and six (13.63%) patients, respectively. UAT scans were obtained for postoperative follow-up in 29 (65.90%), preoperative assessment in 12 (27.27%) and assessment of blast trauma in the absence of,direct abdominal trauma in three (6.81%) patients. The most common finding on LTT was effusion (47.7%). No pathology was observed in 61.36% of the UAT scans, while liver laceration was noted in 20.45%. The total cost of LTT and UAT was almost half that of a total thoracic tomography and a whole abdominal tomography.
CONCLUSION: Selective lower thoracic and upper abdominal tomography obtained following a gunshot injury may be used not only to detect pathology but also as an efficacious, fast, reliable and cost-effective imaging method.