PENETRATING COLON INJURIES

In this study, 48 penetrating colon injuries treated between 1986-1994 in Çukurova University, School of Medicine, General Surgery Department were evaluated retrospectively. 30 (62.5%) cases had gunshot wounds, 18 (37.5%) had stab wounds. Colon Injury Scores (CIS) were as follows: 32 (66.6%) grade II, 5 (10.4%) grade III, 8 (16.7%) grade IV, 3 (6.3%) grade V. Nine (18.7%) cases were managed by primary repair, whereas 39 (81.3%) cases were treated by colostomy procedures. The small bowel was the most frequently injured organ in colonic injury patients (50%). The complication rate was 20.8 percent. The mortality rate 14.6percent. The parameters increasing the risk of morbidity were as follows: CIS equal or greater than grade IV, Penetrating Abdominal Trauma Index (PATI) score over 20, Flint Colon Injury Score (FCIS) grade III, concomitantly organ injuries more than 2, blood transfusion over 3 units. Additionally to these parameters (excluded CIS), we observed that PATI score over 30 was increasing the mortality rate. Penetrating colon injuries without risk factors listed above, PATI score under 25 and FCIS grade I-II, can be managed by primary repair. In cases PATI score was over 25 and FCIS grade III, we believe that choosing colostomy procedures to be appropriate.

PENETRAN KOLON YARALANMALARI

1986-1994 yýllarý arasýnda Çukurova Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý'nda penetran kolon yaralanmasý nedeniyle opere edilen 48 olgu retrospektif olarak incelendi. Kolon yaralanmasý 30 (%62,5) olguda ateþli silah, 18 (%37,5) olguda delici kesici alet yaralanmasý sonucu oluþtu. Olgularýn 32 (%66,6)'sinde grade II, 5 (%10,4)'inde grade III, 8 (%16,7)'inde grade IV, 3 (%6,3)'ünde grade V yaralanma mevcuttu. Dokuz (%18,7) olguya primer sütür, 39 (%81,3) olguya kolostomi prosedürleri uygulandý. Kolon yaralanmasýna en sýk ince barsak yaralanmasý eþlik etmekte idi (%50). On (%20,8) olguda postoperatif komplikasyon geliþti. Yedi (%14,6) olgu exitus oldu. Kolon yaralanma derecesinin IV ve üzerinde olmasý Kolon Yaralanma Skoru (FKYS)'nun grade III olmasý, birlikte yaralanan organ sayýsýnýn 2 ve üzerinde olmasý, 3 ünite ve üzerinde kan transfüzyonu gereksinimi postoperatif komplikasyon riskini artýran parametreler olarak bulundu. Kolon yaralanma derecesi dýþýnda bu parametrelere ilave olarak PATÝ deðerini 30'un üzerinde olmasý ise mortalite açýsýndan önemli bulundu. Penetran kolon yaralanmalarýnda yukarýda sayýlan risk fraktürleri olmaksýzýn PATÝ deðeri 25'in altýnda FKYS grade I ve II olgularda primer sütür, PATÝ deðerinin 25'in üzerinde ve FKYS grade III olgularda kolostomi prosedürlerinin seçilmesinin uygun olacaðý düþüncesindeyiz.