Das penetrierende Trauma des K�rperstamms

Bowley, Douglas M.; Boffard, Kenneth D.

doi:10.1007/s001130170017

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…Bununla paralel olarak birçok ülkede penetran karın travmaları şehir hayatının en sık karşılaşılan ve cerrahi girişim gerektiren sorunlarından biri olmaya devam etmektedir (6). Penetran yaralanmalarda ince bağırsakların yaralanma insidansı ASY'larda %60-80, KDAY'larına bağlı olarak ise %30 olarak bildirilmektedir (7,8).…”

Section: Discussionunclassified

The Effective Factors on Morbidity Due to Penetrating Small Intestine Injuries

Önder¹,

Kapan²,

Başol³

et al. 2012

JAEM

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Objective:In this study, we aimed to investigate the effective factors on morbidity due to small intestine penetrating injuries. patients who underwent surgery due to penetrating small intestine injuries were retrospectively reviewed. Results: The mean age was 32.8±12.3years (15-77), and there were 96 patients, (84.2%) male and 18 (15.8%) female patients. The most common etiologic cause was gun-shot injuries (66.7%). Fifty-one (44.7%) patients had isolated small intestine injuries and 63 (55.3%) had small intestine and additional organ injuries. Colon was the most common additional organ injured (66.7%) Most commonly, 68 (59.7%) patients underwent primary suture. T Postoperative morbidity occurred in 30 patients (25%) and the most common complication was wound infection. The morbidity was significantly higher in the patients with small intestine and additional organ injuries (p=0.006). The morbidity was higher in patients who exhibited signs of peritonitis (p=0.048) and had colonic injuries (p=0.002). The number of blood transfusions was effective in mortality (p<0.001). The mean length of hospital stay was 6.9±2.9 (1-21) days, significantly longer in the patients who developed morbidity (p=0.002). Seven (6.1%) patients died due to hemorrhage in 6 patients and anastomotic leakage in 1 patient. Conclusion: Small intestine injuries significantly increase the postoperative morbidiy when accompanied by additional intraabdominal organ injuries, especially the colon. (JAEM 2012; 11: 204-7) Kolon, n (%) 42 (49.4) Mide, n (%) 13 (15.3) Karaciğer, n (%) 9 (10.6) Böbrek, n (%) 4 (4.7) iliak ven, n (%) 4 (4.7) Pankreas, n (%) 3 (3.5) Duodenum, n (%) 3 (3.5) Dalak, n (%) 2 (2.4) VCİ, n (%) 2 (2.4) Rektum, n (%) 2 (2.4) Safra kesesi, n (%) 1 (1.2) Tablo 2. Yandaş organ yaralanmaları Yaş (yıl) 32.8±12.3 (15-77) Cinsiyet Erkek, n (%) 96 (84.2) Kadın, n (%) 18 (15.8) Hastaneye başvuru süresi (saat) 2.2±1.3 (1-8) Yaralanma tipi Ateşli silah yaralanması, n (%) 76 (66.7) Kesici-delici alet yaralanması, n (%) 38 (33.3) Ameliyata alınma nedeni Periton irritasyon bulguları, n (%) 85 (74.6) Hemodinamik anstabilite, n (%) 19 (16.7) Eviserasyon, n (%) 10 (8.8) Tek bir yerde ince bağırsak yaralanması, n (%) 23 (20.2) Multıbl ince bağırsak yaralanması, n (%) 91 (79.8) İzole ince bağırsak yaralanması, n (%) 51 (44.7) Yandaş organ yaralanması, n (%) 63 (55.3) Ekstra abdominal organ yaralanması, n (%) 13 (11.4) ISS değerleri 17.2±6.9 (9-34) Toplam kan transfüzyonu (ünite) 0.8±1.1 (0-6) Morbidite, n (%) 30 (26.3) Mortalite, n (%) 7 (6.1) Hastanede yatış süresi (gün) 6.9±2.9 (1-21) ISS: Organ yaralanma şiddet skoru Tablo 1. Hastalara ait demografik ve karakteristik klinik bulgular Yara yeri enfeksiyonu, n (%) 13 (43.3) Pulmoner, n (%) 7 (23.3) Yara yeri ayrışması, n (%) 5 (16.7) İntraabdominal abse, n (%) 4 (13.3) Eviserasyon, n (%) 1 (3.3) Tablo 3. Komplikasyonlar JAEM 2012; 11: 204-7 Önder et al. Morbidity in Small Intestine Injuries

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Section: Discussionunclassified

The Effective Factors on Morbidity Due to Penetrating Small Intestine Injuries

Önder¹,

Kapan²,

Başol³

et al. 2012

JAEM

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“…Thoracotomy should performed in blood loss ‡ 1500 ml. Thora- Geröntgt wird erst nach Anlage der TD, welche sowohl in der präklinischen Phase als auch im Schockraum anhand klinischer Parameter indiziert und gelegt werden muss [4,6]. Die TD hat einen hohen diagnostischen und therapeutischen Stellenwert und erlaubt je nach Fördermenge ein selektiv konservatives Vorgehen.…”

Section: Zusammenfassungunclassified

“…Nur wenige Autoren fordern das selektive Vorgehen auch für SV [19,20]. Dabei werden Organbeteiligungen nach abdomineller SV in 58-98 % beschrieben [4,19]. Im eigenen Kollektiv waren es 70 %.…”

Section: Abbunclassified

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Penetrierende Verletzungen - eine wachsende Gefahr in Westeuropa

Hindel¹,

Hildebrand²,

Staubach³

et al. 2007

Viszeralchirurgie

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“…Penetrating trauma · Multiple injury · Fluid resuscitation · Volume therapie · Permissive hypotension [3,7,13,14,16,18,20]. So lautet die Priorität der Behandlung von Patienten mit penetrierenden Verletzungen: "Möglichst schneller Transport".…”

Section: Introductionunclassified

Erstversorgung einer penetrierenden 2-Höhlen-Verletzung

Bayeff-Filloff¹,

Beck²,

Lackner

et al. 2002

Der Unfallchirurg

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We report the rare case of a penetrating, combined thoracic- and abdominal injury as a consequence of a farm work accident. During the recent years, a "treat and run" approach has been increasingly advocated as a time-saving way of treating penetrating injuries, constituting a compromise between the existing strategies of "scoop and run" (used mainly in the USA) and "stay and treat" (preferred in Central Europe). A prolonged rescue response time makes the treat and run approach impossible here. Immediate treatment at the accident site requires an appropriate provision of i.v. fluids. We examine the course of pre-hospital treatment of a trauma patient to illustrate the various approaches to i.v. fluid therapy in relation to rescue response time. However there are only a few studies with a real evidence. If "treat and run" is not possible, the outcome of patients with penetrating trauma can be influenced positively by moderate fluid therapy under continuous monitoring after having reached a constant, low mean arteria pressure (so called permissive hypotension).

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Das penetrierende Trauma des K�rperstamms

Cited by 9 publications

References 37 publications

The Effective Factors on Morbidity Due to Penetrating Small Intestine Injuries

The Effective Factors on Morbidity Due to Penetrating Small Intestine Injuries

Penetrierende Verletzungen - eine wachsende Gefahr in Westeuropa

Erstversorgung einer penetrierenden 2-Höhlen-Verletzung

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