Our experience in the cases with penetrating colonic injuries

BACKGROUND: In this study, the factors that effect the morbidity and mortality in patients with penetrating colonic injuries were evaluated.
METHODS: Fourty-two patients (37 males, 5 females; mean age 30,1; range 14 to 63 years) with penetrating colonic trauma were evaluated according to age, gender, type of penetrating trauma, location and severity of the colonic injury, associated injury, interval between the trauma and the definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality.
RESULTS: Type of the penetrating trauma was stab injury in twenty-eight (67%) patients, and gunshot injury in fourteen (33%) patients. The mean Colon Injury Severity Score was 2,1. The mean Abdominal Trauma Index (ATI) was 17,2 and it was over than 25 in eight (19%) patients. The symptoms of shock were present in eleven (26%) patients at admission. Blood transfusions were applied in sixteen (38%) patients. In twenty-one patients intraabdominal bleeding was observed and it was more than 500 mL in eleven (26%) patients. Primary repair was performed in 36 (86%) of the 42 patients and colostomy was performed in six (14%) patients. Morbidity and mortality rates were 41% and 10% respectively.
CONCLUSION: It was found that morbidity rates were increased in patients with ATI score higher than 25, and mortality rates were increased in patients presenting shock at admission, with the amount of intraabdominal blood more than 500 mL, and who needed three or more units of blood transfusion. The primary repair of the penetrating colon trauma can be performed confidently in the hemodynamicaly stable patients with ATI score less than 25.

Penetran kolon yaralanmalý olgulardaki deneyimlerimiz

AMAÇ: Penetran kolon yaralanmalý olgularda morbidite ve mortaliteye etkili faktörler araþtýrýldý.
GEREÇ-YÖNTEM: Kýrk iki olgu (37 erkek, 5 kadýn; ort. yaþ 30,1; daðýlým 14-63) yaþ, cinsiyet, penetran travmanýn türü, kolonda yaralanma yeri, kolon yaralanmasýnýn þiddeti, ek organ yaralanmasý, yaralanmadan ameliyata kadar geçen süre, hemodinamik durum, kan transfüzyonu, fekal kontaminasyon, cerrahi iþlem, ameliyat sonrasý komplikasyon ve mortalite açýsýndan incelendi.
BULGULAR: Olgularýn 28’inde (%67) kesici delici alet yaralanmasý, 14’ünde (%33) ateþli silah yaralanmasý vardý. Kolon yaralanma þiddeti skoru ortalamasý 2,1 idi. Abdominal Travma Ýndeksi (ATÝ) deðeri ortalama 17,2 olup, sekiz olguda (%19) 25’in üzerindeydi. On bir olguda (%26) baþvuru anýnda þok tablosu vardý; on altý olguya (%38) kan transfüzyonu yapýldý. Yirmi bir olguda karýn içi hemoraji vardý ve bu durum on bir olguda (%26) 500 ml’nin üzerinde idi. Olgularýn 36’sýna (%86) primer tamir, altýsýna (%14) stomalý ameliyatlar uygulandý. Morbidite ve mortalite oranlarý sýrasýyla %41 ve %10 bulundu.
SONUÇ: Abdominal Travma Ýndeksi deðerinin 25 ve üstünde olmasýnýn morbiditeyi artýrdýðý; baþvuru anýnda þok tablosu, ameliyatta karýn içi serbest kan miktarýnýn 500 ml’den fazla olmasý, üç ünite ve daha fazla kan transfüzyonu yapýlmasýnýn da mortaliteyi anlamlý olarak artýrdýðý bulundu. Hemodinamisi stabil ve ATÝ skoru 25’in altýnda olan penetran kolon yaralanmalý hastalarda primer onarým güvenle uygulanabilir.