Background
Bleeding is the major problem in warfarin pretreated patients especially who need emergency surgerical procedures. APH is a hemostatic agent with ultra-hydrophilic and particulate properties. This study aimed to evaluate the in vivo hemostatic effect of APH in rats pretreated with warfarin.
Methods
Forty eight Wistar rats were divided into two main groups: one group was pretreated with warfarin and the other group was not. These two groups was further divided into 3 subgroups according to the administration of APH, wheat meal or saline, for a total of 6 subgroups. Standard full thickness tissue defects were performed on the back of the rats. Saline, wheat meal or APH were administered to the bleeding defect site in both main groups. Haemostasis time and amount of bleeding were calculated.
Results
The bleeding time in rats administered APH was significantly shorter than those administered wheat meal and saline and consequently amount of bleeding was significantly less than those of the control groups.
Conclusion
APH has an effective hemostatic property in rats pretreated or non-pretreated with anticoagulants. Hemostatic agents can be usefull for external bleedings which are growing because of anticoagulation.

Background: Alvarado score is usually evaluated for patients who suffer from appendicitis. The goal of this study was to compare the Alvarado scores in patients who suffered from abdominal pain regardless of their causes.
Materials and methods: In a prospective study, 300 patients with acute abdominal pain who were referred to an Emergency Room were evaluated for Alvarado score regardless of the cause of the pain.

Results: From 300 patients, 257 patients (85.66%) had Alvarado scores 7 or less and 43 patients (14.33%) had Alvarado scores higher than 7. In this study, 66 patients from (25.7 %) with Alvarado scores 7 or less had Appendicitis, compared with 40 patients (93%) with Alvarado scores higher than 7, which showed statistically significant differences.This finding suggests that patients with abdominal pain and Alvarado score>7 are very likely suffered from Appendicitis. This scoring system seems to have 95% specificity for Appendicitis but a poor sensitivity (37%).
Conclusion: Alvarado scoring system in patients with acute abdominal pain could be used to predict Appendicitis. A positive test (Alvarado >7) would result in a 93% chance of appendicitis, whereas a negative test (Alvarado ≤ 7) would result in a 26% chance of appendicitis. So, this is a good rule-in test, but not an adequate rule-out test.

Background
Spleen is the most easily injured organ in abdominal traumas. Several reports about successful non-operative management and modern diagnostic imaging have progressively allowed the diffusion of a conservative approach.
The aim of our retrospective study was to compare Non Operative Management with surgery.
Methods
We compared seven patients subjected to NOM, between 2007 and 2011, with six patients undergoing OM with similar preoperative characteristics.
Results
Average hospital stay was lower in NOM group than in patients with OM, although not statistically significant. NOM group required significantly fewer transfusions, and no patient in this group, necessitated a period of intensive care unit stay, while 83% of patients recovering from OM needed it. The failure rate of NOM was in our experience 14.3%.
Conclusions
In our experience, NOM was the treatment of choice, thanks to several advantages, in blunt splenic injuries grade I, II and III. NOM is slightly less than surgery, but this is an unadjusted comparison and the 95% confidence interval is extremely wide - from 0.04 to 16.99. Splenectomy was the chosen technique in patients with exclusion criteria for NOM, as well as in those with grade IV and V injury.

Amaç: Karaciðer karýn travmalý hastalarda en sýk yaralanan solid bir organdýr. Biz bu çalýþmada tedavisinde ve takibinde herhangi bir invaziv tanýsal giriþim yada cerrahi müdahale yapýlmayan bir grup künt karaciðer travmalý hastayý sunmayý amaçladýk.
Gereç ve yöntem: Genel cerrahi kliniðine yatýrýlan ve bunun yanýsýra ek yaralanmalarý sebebiyle diðer kliniklere yatýrýlýp genel cerrahi tarafýnda bu kliniklerde takibi yapýlan toplam künt karaciðer yaralanmasý olan 80 hasta nonoperatif olarak izlendi. Normal daðýlým gösteren veriler student’s t-testi veya tek yönlü varyans analizi ile deðerlendirildi. Anormal daðýlým gösteren veriler ise Mann-Whitney U testi veya Kruskal-Wallis varyans analizi ile incelendi. Kategorik veriler Chi–square testi ile analiz edildi ve p < 0.05 istatistiksel olarak anlamlý kabul edildi.
Bulgular: Takip edilen hastalarýn hemoglobin düzeyleri, karaciðer yaralanma derecesi ve taburcu olmasý ile yaralanma mekanizmasý arasýnda istatistiki olarak anlamlý bir iliþki bulunamadý. Ayný zamanda karaciðer yaralanmasý derecesi, taburcu olmasý ve yaralanma mekanizmasý ile ALT ve AST deðerleri arasýnda da istatistiki olarak anlamlý bir iliþki yoktu. Hastalarýmýzýn hiçbirinde ölüm vakasý olmadý.
Sonuç: Karaciðer yaralanmasýnýn taný ve tedavisinde son yirmi beþ yýl boyunca hayatta kalma süresini uzatan deðiþiklikler olmuþtur. Nonoperatif management of liver injury (NOM) hemodinamik olarak stabil olan karaciðer travmalý hastalarýn takip ve tedavisinde altýn standart olarak görülmektedir.
Anahtar sözcükler: Karaciðer, Travma, nonoperatif yaklaþým

Background: Liver is the most frequently injured organ during abdominal trauma. We present a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and/or surgical intervention.
Methods: A total of 80 patients with blunt liver injury who hospitalized to the general surgery clinic, as well as to other clinics because of the concomitant injuries were followed non-operatively. The normally distributed numeric variables were evaluated by Student’s t-test or one way analysis of variance, while non-normally distributed variables were analyzed by Mann-Whitney U test or Kruskal-Wallis variance analysis. Chi–square test was employed for the comparison of categorical variables. Statistical significance was assumed for p < 0.05.
Results: There was no significant relationship between patients’ Hgb level and liver injury grade, outcome and mechanism of injury. Also there was no relationship between liver injury grade, outcome and mechanism of injury and ALT levels as well as AST level. There was no mortality in any of the patients.
Conclusion: Changes during the last quarter of century in the diagnosis and treatment of liver injury are associated with increased survival. Nonoperatif management of liver injury (NOM) in hemodynamically stable patients with hepatic trauma seems to be the gold standard.
Keywords: Liver, Trauma, nonoperatif management

Background: Lately, FAST is preferred over DPL as adjunct to primary survey. However, this is not evidence based as there has been no randomized trial.
Methods: 200 consecutive torso trauma patients meeting inclusion criteria were randomized to undergo either DPL or FAST. The results were then compared with either contrast enhanced computerized tomography (CECT) (in patients managed non-operatively) or laparotomy findings (in patients undergoing operative treatment). Outcome parameters were: result of the test, therapeutic usefulness, role in diagnosing bowel injury and time taken to perform the procedure.
Results: 200 patients with mean age of 28.3 years were studied, 98 in FAST and 102 in DPL group. 104 sustained blunt trauma and 76 sustained penetrating trauma due to stabs. 38 (38.7%) were FAST positive and 48 (47%) were DPL positive (p=0.237, not significant). As a guide to therapeutically beneficial laparotomy, negative DPL was better than negative FAST. For non-operative decisions, positive FAST was significantly better than positive DPL. DPL was significantly better than FAST in detecting as well as not missing the bowel injuries. DPL took significantly more time than FAST to perform.
Conclusions: This study shows that DPL is better than FAST.

AMAÇ: Fournier gangreni (FG) ciltaltý ve fasial dokularýn hýzlý seyirli, nekrotizan ve ölümcül enfeksiyöz bir hastalýðýdýr. Bu çalýþmada, tersiyer bir referans hastanesinde 68 hastaya ait prognostik faktörleri ve tedavi sonuçlarýný irdelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2006 ve Ocak 2013 tarihleri arasýnda acil servise baþvuran hastalar iki gruba ayrýldý ve geriye dönük olarak incelendi. Grup I’deki (G1) hastalar bir debridman gereksimi duyanlar ve Grup II’deki (G2) hastalar birden fazla debridman gereksinimi olanlardý. Demografik ve klinik özellikler kaydedildi. Fournier gangreni þiddet indeksi (FGSI) puanlarý, nötrofil-lenfosit oranlarý (NLO) ve trombosit-lenfosit oranlarý (TLO) hesaplandý. Prognostik faktörler gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda yaþ ortalamasý, kadýn-erkek oraný, baþvuru anýndaki belirti süresi yönünden fark yoktu ama enfeksiyon kaynaðý, predispozan faktör, pozitif kültür sonuçlarý G2’de yüksekti. Hastanede kalýþ süresi, toplam maliyet ve mortalite oraný da G2’de yüksekti. G2’de NLO ve TLO yönünden istatistiksel olarak anlamlý yükseklik vardý ama FGSI skorlarý yönünden gruplar arasýnda fark saptanmadý.
TARTIÞMA: Bulgularýmýza göre FGSI puanlama sisteminin prognoz belirlemede deðeri yoktu. Buna karþýlýk daha önce Ýngilizce literatürde bu amaçla kullanýmýna rastlayamadýðýmýz NLO ve TLO deðerli bulundu.

BACKGROUND: Fournier’s gangrene (FG) is a rapidly progressive and necrotizing infection of the subcutaneous and fascial tissues with a high mortality rate. In the present study, we aimed to investigate prognostic factors and analyze the outcomes of 68 patients in a tertiary reference hospital.
METHODS: Patients admitted to the emergency department were investigated retrospectively between January 2006 and January 2013 and divided into two groups. The patients in Group I (G1) required one debridement, and Group II (G2) patients required more than one. Patient demographic and clinical characteristics were encoded. Fournier’s Gangrene Severity Index (FGSI) scores, neutrophil-lymphocyte ratios (NLR), and platelet-lymphocyte ratios (PLR) were calculated. Prognostic factors were compared between the groups.
RESULTS: There were no statistically significant differences between the groups in terms of mean age, female-male ratio, or duration of symptoms on admission; however, there were more infection sources, predisposal factors, and positive culture results in G2. Additionally, hospital stay, total cost, and mortality rate values were high in G2. We found statistically higher NLR and PLR ratios in G2, but there was no significant difference in FGSI scores between the groups.
CONCLUSION: The FGSI scoring system was not found to be valuable in determining prognosis. However, NLR and PLR were valuable, and previous use of NLR and PLR for determining Fournier’s gangrene prognosis could not be found in the English literature.

Background: This study analyzed the clinical characteristics and prognosis of pelvic bone fractures, the occurrence of accompanying intra-abdominal solid organ injury and the risk factors for intra-abdominal solid organ injury.
Methods: Medical records were retrospectively collected. The subjects were divided into the solid organ and the non-solid organ injury group, with respect to intra-abdominal solid organ injury, to compare demographics, outcomes and prognosis. Risk factors for the occurrence of intra-abdominal solid organ injury in patients with pelvic bone fractures were evaluated.
Results: The solid organ injury group comprised 69 (17.4%) patients. Fall height was greater in the solid organ injury group than the non-solid organ injury group. Initial blood pressure and Revised Trauma Scores were lower in the solid organ injury group. Shock immediately after emergency department arrival was a risk factor for intra-abdominal solid organ injury in trauma patients with pelvic bone fractures. The prognosis of the solid organ injury group was poor and more invasive treatment was performed in this group.
Conclusions: Patient prognosis needs to be improved through early diagnosis and aggressive treatment according to the early prediction of intra-abdominal solid organ injury in trauma patients who present at the emergency department with shock and suspicion of pelvic bone fracture.

Amaç: Önkol, el yaralanmalarý iþle iliþkili özrün temel nedenidir. Çalýþma el ve önkol yaralanmalarý sonrasý yaralanma ciddiyetleri ile iþe geri dönüþ süresi, aktivite ve katýlým düzeyleri arasýndaki iliþkiyi incelemek amacýyla planlanmýþtýr.
Gereç-Yöntem: Çalýþmaya yaþ ortalamalarý 31±11,13 yýl (18-63 yýl) olan el ve önkol yaralanmalý toplam 130 hasta dahil edilmiþtir. Modifiye El ve Önkol Yaralanmasý Ciddiyet Skorlamasý (MEYCS) ile yaralanma ciddiyeti belirlenmiþtir. Yaralanmadan sonra 8.haftada Jebsen El Fonksiyon Testi (JEFT), Buck-Gramko skorlamasý uygulanmýþtýr. Bozukluk/semptom skorunun deðerlendirilmesi için 12. haftada Kol, Omuz ve El Sorunlarý Anketi’nin Türkçe versiyonu (DASH-T) kullanýlmýþ, kavrama kuvveti ölçümü yapýlmýþtýr. Hastalarýn iþe geri dönüþ süreleri kaydedilmiþtir.
Bulgular: Çalýþmanýn sonunda MEYCS ile hastalarýn eski iþlerine geri dönüþ süresi, kavrama kuvveti deðerleri, DASH-T skorlarý ve Buck Gramko skorlarý arasýnda istatistiksel olarak anlamlý iliþki olduðu gözlenmiþtir (p< 0,05). MEYCS ile JEFT arasýnda istatistiksel olarak anlamlý iliþkiye rastlanmamýþtýr (p>0,05). Hastalar UFÖSS sistemine göre deðerlendirildiðinde; vücut iþlevleri bölümünde vücut yapý ve fonksiyonlarý (1,86±1,47), aktivite bölümünde yazý yazmada (2,06±1,50) en yüksek bozukluk düzeyine sahip olduklarý bulunmuþtur.
Sonuç: Sonuç olarak yaralanma ciddiyet düzeyinin yüksekliði aktiviteye geri dönüþü, katýlýmý, iþe geri dönüþü geciktirmiþtir. DASH-T skorlarýnýn iþe geri dönüþe en fazla etki eden faktör olduðu sonucuna varýlmýþtýr. Ayrýca el, önkol yaralanmalý hastalarda, aktiviteye geri dönüþ ve katýlým ile iþe geri dönüþ zamaný arasýnda pozitif iliþki vardýr.

Background: Forearm, hand injuries are the main cause of work-related disability. This study was planned to investigate the relationship between severity of injury, return to work, impairment, activity participation in patients with hand, forearm injuries.
Methods: Thirty patients have had forearm, hand injuries with mean age of 31±11,13 years were participated. Injury severity was evaluated with Modified Hand and Forearm Injury Severity Scoring (MHISS) after surgery. Patients were evaluated with Jebsen Hand Function Test (JHFT), Buck-Gramko scoring at 8th week. Also grip strength was evaluated with dynamometer, disability/symptom score was evaluated with Turkish version of Disabilities of the Arm, Shoulder, and Hand (DASH-T) questionnaire at 12th week of injury.
Results: It was found a statistically significant relation between MHISS, hand strength, time of return to work, DASH-T ve Buck-Gramko scores in patients with forearm, hand injuries (p≤ 0,05). It was found higher impairment level at body structure and body functions (1,86±1,47) in body functions level, writing (2,06±1,50) in activity regarding ICF framework.
Conclusion: It was concluded that return to work and activity and participation is delayed in the higher score of MHISS. DASH-T scores was the most important factor in returning to work. Also there is a positive relation between return to work, activity and participation in patients.

AMAÇ: Ýnvajinasyon pediatrik yaþ grubunda önemli bir intestinal obstruksiyon nedenidir. Ultrason eþliðinde hidrostatik redüksiyon invajinasyon tedavisinde popüler bir yöntemdir. Bu çalýþmada ultrason ile invajinasyon tanýsý konan hastalarýn demografik özellikleri, tedavi yaklaþýmlarýný paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM
Aðustos 2011-Mayýs 2013 tarihleri arasýnda ultrason ile invajinasyon tanýsý konan 41 olgu retrospektif olarak incelendi. Bu vakalardan klinik kontrendikasyonu bulunmayan 24’üne ultrason eþliðinde hidrostatik redüksiyon ile tedavi uygulandý.
BULGULAR
Olgularýn 24’ü erkek, 17’si kýz olup erkek kýz oraný 1.4: 1 olarak bulundu. Olgularýn çoðunluðu 6-24 ay ve 2-5 yaþ aralýðýnda saptandý. Yaþ ortalamasý 31,12±26,32 (3-125) ay idi. Olgular en sýk nisan ve mayýs aylarýnda saptandý. Klinik kontrendikasyonu bulunan 17 olgu doðrudan cerrahiye alýndý. Ultrason eþliðinde hidrostatik redüksiyon yapýlan 24 olgudan 20’sinde redüksiyon saðlandý. Bu olgularýn 3’ünde rekürrens saptandý. 3 olgudan 2 sine tekrar hidrostatik redüksiyon yapýlýp baþarý saðlandý. Diðer olgu cerrahiye alýndý. Toplamda 24 olguya 26 kez hidrostatik redüksiyon denenmiþ olup 22’sinde baþarý saðlandý (%84.6). Olgularda iþleme baðlý komplikasyon görülmedi.
SONUÇ
Ultrason eþliðinde hidrostatik redüksiyon, yüksek baþarý oranlarý ve radyasyon riskinin bulunmamasý nedeniyle invajinasyon tanýsý alan çocuklara tedavi yaklaþýmýnda ilk seçenek olmalýdýr.

BACKGROUND: Intussusception is one of the important cause of intestinal obstruction in children.Hydrostatic reduction under ultrasound guidance is a popular treatment method of intussusception.We aimed to explain the demographic characteristics, treatment approaches in patients diagnosed with intussusception by ultrasound.
METHODS: Forty one patients diagnosed with intussusception by ultrasound between August 2011-May 2013 were retrospectively analyzed.Twenty-four of these patients which didn’t have any contraindication had ultrasound guided hydrostatic reduction as a treatment.
RESULTS: Twenty-four of the patients were male,17 of the patients were female where there was a 1.4: 1 ratio of male to female.The majority of the patients were between the ages of 6-24 months and 2-5 years.Mean age was 31,12±26,32(3-125) months.Patients were more frequently diagnosed in april and may.Seventeen patients which had clinical contraindication enrolled directly to surgery.In 20 of 24 patients who had ultrasound guided hydrostatic reduction, reduction was achieved.Three of them there was recurrence.In 2 of these patients successful reduction was achieved with second attempt.The remaining patient was enrolled to surgery.For these 24 patients hydrostatic reduction was performed for 26 times and in 22 of them success was achieved(84,6%).There was no procedure-related complications in patients.
CONCLUSÝON: Ultrasound guided hydrostatic reduction with high success rates and having no radiation risk,should be the first choice for therapeutic approach in children diagnosed with intussusception.

AMAÇ
Çocukluk çaðýnda, sýklýkla künt travma sonrasý geliþen böbrek yaralanmalarý nonoperatif olarak baþarýyla tedavi edilebilmektedir. Bu çalýþmada, çocuklarda künt travma sonucu geliþen böbrek hasarý olan hastalar deðerlendirildi.

GEREÇ VE YÖNTEMLER
Bu çalýþmada Ocak 2000 ile Mart 2012 yýllarý arasýnda künt karýn travmasý sonrasý böbrek hasarý nedeniyle çocuk cerrahi servisine baþvuran 41 çocuk hastanýn bilgilerine ulaþýldý. Hasta verileri geriye dönük olarak, demografik karakteristik özellikleri, hastanede kalýþ süresi, travma etkeni, tedavi, ve sonuçlarý açýsýnda deðerlendirildi.

BULGULAR
Olgularýn yaþ ortalamasý 10±4,85 idi. Böbrek hasarý; Grade 1 (n=13), Grade 2 (n=13), Grade 3 (n=6), Grade 4 (n=6), ve Grade 5 (n=3) mevcut idi. Bütün olgular baþlangýçta konservatif olarak takip edildi. Bütün olgulardan 7 olguya cerrahi tedavi uygulandý. Cerrahi tedavi olarak olgulara nefrektomi(n=3), mesane onarýmý(n=1), piyeloplasti(n=1), ileum onarýmý(n=1), ve üretra onarýmý(n=1), yapýldý. Hiçbir olguya geç dönem cerrahi tedavi gerekmedi. Olgulardan hayatýný kaybeden olmadý.

SONUÇ
Çocuklarda böbrek yaralanmalarýnda, konservatif tedavi etkili ve güvenilirdir. Çoðu böbrek hasarý cerrahi gerektirmemesine raðmen, hasarýn derecesine bakýlmaksýzýn hayatý tehdit eden kanamalara cerrahi müdahale yapýlmadýr.

BACKGROUND
Renal injuries often related blunt trauma are successfully treated with nonoperatively in childhood. In the present study, patients with renal damage were evaluated to caused by blunt trauma in children.

MATERÝALS AND METHODS
In the present study, between January 2000 and March 2012, medical record of 41 cases were admitted to pediatric surgery related renal injury after blunt abdominal trauma. Cases’ demographic characteristics, duration hospitalization, cause of trauma, treatment, and outcomes were analyzed retrospectively.
RESULTS
The mean age was 10 ± 4,85. Renal damage; Grade 1 (n = 13), grade 2 (n = 13), Grade 3 (n = 6), Grade 4 (n = 6), and Grade 5 (n = 3) were present. All patients were initially treated conservatively. Seven patients were underwent surgical treatment. Surgical treatment was nephrectomy (n = 3), pyeloplasty (n = 1), bladder (n = 1), ileum (n = 1), and urethra repair (n = 1). Surgical treatment was not required in long term in all cases. There was no death.

CONCLUSÝONS
The conservative treatment of pediatric renal injuries is safe and effective. Although the vast majority of renal injuries do not require surgical intervention, life-threatening renal bleeding, regardless of the grade of injury, should be treated with immediate surgery.

We reported a patient of delayed huge intrahepatic hematoma and transient decline in hemoglobin to 62 g/L 18 days after liver injury. Abdominal computed tomography revealed seriously flattening of inferior vena cava, which was consistent with compression by the enlarging hematoma. Although traditionally there was no indication for surgical intervention, the patient developed acute liver failure with a progressive increase in liver enzymes and bilirubin. We postulated the ever-expanding hematoma may have led to dramatically elevated intrahepatic pressures that in turn restricted hepatic vein reflux and subsequently acute liver failure. Therefore, she underwent percutaneous drainage and the decompression instantly reversed the liver injury. This phenomenon is similar with the well-described abdominal compartment syndrome, which is defined as new onset organ dysfunction or failure secondary to sustained intraabdominal hypertension and decompression is the standard treatment.

Sfenoid sinüs içi yabancý cisim genellikle kraniyal ve/veya orbital travma ve intrakraniyal lezyonlarla iliþkili olarak görülen çok nadir olaylardýr. Biz bu yazýda iþ kazasý sonrasýnda geliþen, intrakraniyal uzanýmý olan sfenoid sinüs içi metalik yabancý cisim olgusunu sunmaktayýz. Yirmi dokuz yaþýnda erkek hasta sað orbial travma sonrasý kliniðimize gönderilmiþ. Çekilen kafa grafisi ve bilgisayarlý tomografide sol temporal fosaysa invazyon gösteren sfenoid sinüs içinde yabancý cisim saptandý. Hasta endoskopik endozal teknikle opere edilerek yabancý cisim çýkartýldý ve defekt bulunan kafa kaidesi çok tabakalý olarak tamir edildi. Operasyon anýnda ve sonrasýnda komplikasyon görülmeyen hastanýn 3 aylýk takiplerinde de sorun yaþanmadý.

Sphenoidal sinus foreign bodies are very rare entities which are often associated with a cranial and/or orbital trauma. In this paper, a case of a metallic foreign body pierced the sphenoid sinus and penetrated into the intracranial space due to a work accident was presented. Twenty-nine year old male was refered to our clinic because of a right orbital penetrating trauma. Skull x-ray and computed tomography (CT) scans demonstrated a foreign body inside the sphenoidal sinus, extending to the left temporal fossa. The foreign body was removed using endoscopic endonasal technique and skull base was reconstructed with multilayer closure technique. There were no complications during or after the operation. Postoperative result was perfect with 3 months of follow up.

Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death.
We present a case of 27 year old male with NF. He was admitted to the regional hospital the day after blunt abdominal trauma. The following day he was referred to our hospital where he was operated on urgently. Previously he was treated in a regional hospital immediately after injury for diffuse abdominal pain and large hematoma of anterior abdominal wall. Injury was obtained while driving a bike and falling over handlebar. Due to worsening of general condition he was referred to our hospital. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery the fulminant necrotizing fasciitis has developed. The antibiotics were prescribed according to wound cultures. Subsequent necrectomies were performed and after 25 days the reconstruction of abdominal wall with skin graft was obtained. Despite all resuscitation measures including fluids, blood transfusions and parenteral nutrition, the lung infection and MODS caused death 42 days after initial operation.
Blunt abdominal trauma could bring rupture of intestine, and in early signs of peritoneal irritation the emergency laparotomy should be performed. Disastrous complication are rare but lethal.

Pneumomediastinum is air leakage to mediastinal space from various potential sites, including lung, esophagus, trachea, and neck. It is a rare condition that develops either spontaneously with increased intraalveolar or intrabronchial pressure, or due to trauma. Although cases with face or neck trauma with subcutaneous emphysema that extended to mediastinal cavity via anatomical connections in face and neck have been reported, orbital traumas leading to pneumomediastinum is a very rare occurence that that has only been reported in a few reports. This paper reports a 17-year-old male who presented with diffuse subcutaneous emphysema involving paraorbital, facial areas, which extended to neck and mediastinal cavity from there.