Ulus Travma Acil Cerrahi Derg. 2008; 14(3): 205-210

Künt karýn travmasý: Taný yöntemlerinin deðerlendirilmesi ve cerrahi sonuçlar

Ahmet Karamercan¹, Tonguç Utku Yýlmaz¹, Mehmet Akif Karamercan², Bülent Aytaç^1
1Gazi Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý, Ankara
²Gazi Üniversitesi Týp Fakültesi Acil Týp Anabilim Dalý, Ankara

AMAÇ: Bu çalýþmada künt karýn travmasý (KKT) ile baþvuran hastalarda uygulanan tanýsal testlerin ortaya konulmasý ve bunlarýn cerrahýn kararlarý üzerine olan etkilerinin incelenmesi amaçlanmýþtýr. GEREÇ-YÖNTEM: GÜTF'ne Mayýs 2003-Mayýs 2005 tarihleri arasýnda KKT nedeniyle baþvuran 144 hasta retrospektif olarak incelendi.Hastalar yaþ, cinsiyet, yaralanma mekanizmasý, Glasgow koma skalasý,revise edilmiþ travma skoru,izlem periodu, uygulanan tanýsal testler ve tedavi yöntemleri açýsýndan deðerlendirildi. BULGULAR: Hastalarýn 98’i erkek ve 46’sý kadýn olup ortalama yaþlarý 36yaþ(17-84yaþ) olarak bulundu. Travma nedeni 126(% 87.5)hastada trafik kazasý,14(%9.7) hastada yüksekten düþme,4(%2.8) hastada ise darp olarak tesbit edildi.Hastalarýn 21’inde izole karýn travmasý, 123’ünde ise çoklu sistem travmasý mevcuttu.Hastalarýn 139’una(%97) abdominal ultrasonografi ve 73’üne(%51) abdominal tomografi uygulandý. Diagnostik peritoneal lavaj (DPL) 41(%28.4) hastaya yapýldý ve 15’inde(%37) pozitif olarak deðerlendirildi. 19 hastaya(%13.2) acil laparatomi yapýlýrken;abdominal ultrasonogrofi ve tomografide serbest sývý bulunan ve hemodinamik olarak stabil olan 21 hasta takibe alýndý.Bu hastalardan 2’sine takip esnasýnda laparatomi kararý alýndý ve operasyonda intestinal perforasyon saptandý. Genel mortalite %16,cerrahi uygulanan vakalarda ise mortalite %14.3 olarak bulundu.
SONUÇ: Ultrasonografi,abdominal tomografi ve DPL birbirinin alternatifi olan tetkikler olarak görülmemelidir.Bu tetkikler bir bütünün tamamlayýcýlarý olarak kullanýldýðýnda, künt karýn travmasýna sekonder solid organ yaralanmasý olan bir çok hasta opere edilmeksizin izlenebilecektir. Böylece gereksiz laparotomiler ve bunlarýn neden olacaðý mortalite ve morbiditeler önlenmiþ olacaktýr.

Anahtar Kelimeler: Çoklu travma, gereksiz laparotomi; karýn yaralanmasý/tedavi; künt karýn travmasý; laparotomi; tanýsal testler.

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Blunt abdominal trauma: evaluation of diagnostic options and surgical outcomes

Ahmet Karamercan¹, Tonguç Utku Yýlmaz¹, Mehmet Akif Karamercan², Bülent Aytaç^1
1Department Of General Surgery, Gazi University, Ankara, Turkey
²Department Of Emergency Medicine, Gazi University, Ankara, Turkey

BACKGROUND: In the present study, it is intended to outline the diagnostic tests and their influences on decisions of the surgeon about patients presented with blunt abdominal trauma. METHODS: One hundred forty-four patients (98 males, 46 females; mean age 36; range 17 to 84 years) admitted to Gazi Universty School of Medicine due to blunt abdominal trauma (BAT) between May 2003-May 2005 were reviewed retrospectively. Age, gender, injury mechanism, Glasgow Coma Scale, revised trauma score, follow-up period, applied diagnostic procedures, and treatment methods were evaluated. RESULTS: The underlying cause was traffic accident in 126 (87.5%) patients, fall from height in 14 (9.7%) patients, and blows in 4 (2.8%) patients. Isolated abdominal trauma was seen in 21 patients and multisystem trauma in 123 patients. The most frequent associated trauma was head injury (66.6%). Abdominal ultrasonography (USG) was applied in 139 (97%) of the patients, and abdominal computed tomography (CT) was performed in 73 (51%). Diagnostic peritoneal lavage (DPL) was applied in 41 (28%) patients, and 15 (37%) of them proved to be positive. While emergency laparotomy was applied in 19 (13.2%) of the patients, 21 hemodynamically stable patients were diagnosed to have free fluid through USG and CT and were followed-up. During the follow-up period, 2 patients were scheduled to be operated, and small intestine perforation was found in these patients. The overall mortality rate for all patients was 16%, and the postoperative mortality rate with respect to the operated patients was 14.3%. CONCLUSION: If USG, CT, and DPL are applied in a complementary manner, a large number of patients with solid organ injuries secondary to blunt trauma can be managed nonoperatively. Thus, unnecessary laparotomies can be avoided and related morbidities and mortalities decreased.

Keywords: Abdominal injuries/therapy, blunt abdominal trauma; diagnostic tests; laparotomy; multiple trauma; unnecessary laparotomy.

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