Batın Travmaları
Özet
Karın yaralanmaları, önlenebilir travma ile ilişkili ölümlerin sık nedenidir. Belirli yaralanmalar için şüphe uyandıran yaralanma mekanizmasını anlamak, yaralanmaların gözden kaçma riskini azaltacaktır. Penetrasyon, kanama ve perforasyonun erken belirtilerini tanımak ve önemli bir yaralanmanın varlığını doğrulamak için görüntüleme modalitesini seçmek, daha erken teşhis, komplikasyonların önlenmesi ve daha iyi sonuçlar elde edilmesine sağlayacaktır. Genel olarak abdominal yaralanmalarının ve özel olarak intraabdominal organ yaralanmalarının klinik özelliklerini bilmek, yoğun bakım ünitesinde bu hastaların yönetilmesinde sağlam kararlar verme yeteneğini artırır.
Yoğun bakım ünitesinde hasta izleme, abdominal travmanın cerrahi olmayan tedavisi, komplikasyonların erken tespiti ve cerrahiye geri dönme ihtiyacı açısından çok yararlıdır. Hasar kontrol laparotomisi geçiren hastalar, vital bulgular, koagülopati, asidoz, hipoterminin normalleşmesinin takibi ile cerrahiye geri dönme zamanlamasını belirleme konusunda yoğun bakım izleminden önemli ölçüde fayda sağlar.
Abdominal injury is a common cause of preventable trauma-related deaths. Understanding the mechanisms behind these injuries can help clinicians anticipate specific types of injuries, thereby reducing the risk of overlooking them. Early recognition of signs such as penetration, hemorrhage, and perforation, along with selecting the appropriate imaging techniques to confirm significant injuries, can lead to quicker diagnoses, complication prevention, and improved patient outcomes. Familiarity with the clinical manifestations of both general abdominal injuries and specific organ injuries enhances an intensivist’s ability to make informed therapeutic decisions in the ICU.
Monitoring patients in the ICU is crucial for the nonoperative management of abdominal trauma, enabling early detection of complications and determining the need for surgical intervention. Patients who undergo damage control laparotomy greatly benefit from ICU monitoring to assess the stabilization of vital signs, correction of coagulopathy, reversal of acidosis, resolution of hypothermia, and to appropriately time the return to the operating room for definitive surgery.
Referanslar
Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma 1996; 41: 28–33.
Brooks A, Holroyd B, Riley B. Missed injury in major trauma patients. Injury 2004; 35: 407–412.
Goldberg SR, Anand RJ, Como JJ. Prophylactic antibiotic use in penetrating abdominal trauma: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73: S321–S324.
Al-Mulhim AS, Mohammad HA. Non-operative management of blunt hepatic injury in multiply injured adult patients. Surgeon 2003; 1: 81–86.
Fabian TC, Croce MA. Abdominal trauma, including indications for laparotomy, n Mattox LK, Feliciano DV and Moore EE (eds). Trauma. East Norwalk, Appleton & Lange, 2000, 583–602.
Huizinga WK, Baker LW, Mtshali ZW. Selective management of abdominal and thoracic stab wounds with established peritoneal penetration: The eviscerated omentum. Am J Surg 1987; 153: 564–568.
Robin AP, Andrews JR, Lange DA. Selective management of anterior abdominal stab wounds. J Trauma 1989; 29: 1684–1689.
Moore EE, Moore JB, van Duzer-Moore S. Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg 1980; 140: 847–852.
Demetriades D, Velhmahos GC, Comwell EE III. Selective non-operative management of gunshot wounds of the anterior abdomen. Arch Surg 1997; 132: 178–184.
Velmahos CG, Demetriades D, Toutouzas KG et al. Selective non-operative management in 1,856 patients with abdominal gunshot wounds. Should routine laparotomy still be standard of care? Ann Surg 2001; 234: 395–401.
Liu M, Lee C, Veng F. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 1993; 35: 267–277.
McAlvarak MJ, Shaftan GW. Selective conservatism in penetrating abdominal wounds: A continuing re-appraisal. J Trauma 1978; 18: 206–211. Abdominal Trauma 323
Rozycki GS, Ochsner MG, Schmidt JA et al. A prospective study of surgeon performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma 1995; 39: 492–499.
Neugebauer E, Suaerland S. Guidelines for emergency laparoscopy. World J Emerg Surg 2006; 1: 31–36.
Lenworth M Jacobs, Stephen S Luk, in Advanced Trauma Operative Management, 2nd ed. Woodbury, Ciné-Med Publishing, Inc., 2010.
Paddock HN, Tepas JJ, Ramenofsky ML. Management of blunt pediatric hepatic and splenic injury: Similar process, different outcome. Am Surg 2004; 70: 1068–1072.
Fullen WD, Selle JG, Whitely DH et al. Intramural duodenal hematoma. Ann Surg 197; 179: 549–552.
Cogbill TH, Moore EE, Feliciano DV et al. Conservative management of duodenal trauma: A multicenter perspective. J Trauma 1990; 30: 1469–1473.
Shorr RM, Greaney GC, Donovan AJ. Injuries of the duodenum. Am J Surg 1987; 154: 193–199.
Degiannis E, Krawcrykowski D, Velmahos GC et al. Pyloric exclusion in severe penetrating injuries of the duodenum. World J Surg 1993; 17: 751–755.
Cogbill TH, Moore EE, Kashuk JL. Changing trends in the management of pancreatic trauma. Ann Surg 1978; 187: 555–560.
Feliciano DV, Martin JD, Cruse PA et al. Management of combined pancreaticoduodenal injuries. Ann Surg 1987; 205: 670–673.
Mckone TK, Bursch LR, Schoelten DJ. Pancreaticoduodenectomy for trauma: A lifesaving procedure. Am Surg 1998; 54: 361–369.
Bradley EL III, Clements JL Jr, Gonzales AC. The natural history of pancreatic pseudocysts: A unified concept of management. Am J Surg 1979; 137: 135–141.
Wisner DH, Chun V, Blaisdell FW. Blunt intestinal injury: Key to diagnosis and management. Arch Surg 1990; 125: 1319–1326.
Scherk J, Shatney C,Sensaki K et al. The accuracy of computer tomography in the diagnosis of blunt small bowel perforation. Am J Surg 1994; 168: 670–675.
Hackam D, Ali J, Jastaniah S. Effects of other intra-abdominal injuries on the diagnosis, management and outcome of small bowel trauma. J Trauma 2000; 49: 606–610.
Stone HH, Fabian TC. Management of perforating colon trauma: Randomization between primary closure and exteriorization. Ann Surg 1979; 190: 430–441.
Nelson R, Singer M. Primary repair for penetrating colon injuries. Cochrane Database of Systematic Reviews 2003, Issue 3, Art No CD002247. DOI: ID. 1002/14651858.
Ivatury RR, Licata J, Gunduz Y et al. Management options in penetrating rectal injuries. Ann Surg 1991; 57: 57–64.
Ali J. Abdominal trauma with specific reference to hepatic trauma. Can J Surg 1978; 21: 512–517. 324 The Surgical Critical Care Handbook
Feliciano DV, Mattox KL, Jordan GL Jr. Intra-abdominal packing for control of hepatic hemorrhage: A reappraisal. J Trauma 1981; 21: 285–291.
Pachter HL, Knudson MM, Esrig B et al. Status of non-operative management of blunt hepatic injuries in 1995: A multicenter experience with 404 patients. J Trauma 1996; 40: 31–40.
Malhotra AK, Fabian TC, Croce MA et al. Blunt hepatic injury: A paradigm shift from operative to non-operative management in the 1990’s. Ann Surg 2000; 231: 804–810.
Shapiro MB, Jenkins DH, Schwab CW et al. Damage control: Collective review. J Trauma 2000; 49: 969–982.
Moore EE, Thomas G. Orr Memorial lecture: Staged laparotomy for the hypothermia acidosis and coagulopathy syndrome. Am J Surg 1996; 172: 405–412.
Bryan A, Cotton MD, Brigham K et al. Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma 2009; 66: 41–49.
Smith JS, Cooney RN, Mucha P. Non-operative management of the ruptured spleen: A revalidation of criteria. Surgery 1996; 120: 745–751.
Sclafani SJA, Shaftan GW, Scalea TM et al. Non-operative salvage of computed tomography-diagnosed splenic injuries: Utilization of angiography for triage and embolization for hemostasis. J Trauma 1995; 39: 818–826.
Powell M, Courcoulas A, Gardner M et al. Management of blunt splenic trauma: Significant difference between adults and children. Surgery 1997; 122: 654–659.
Francke EL, Neu HC. Post splenectomy infection. Surg Clin North Am 1981; 61: 135–141.
Sheldon GF, Lim RC, Yee ES et al. Management of injury to the porta hepatis. Ann Surg 1985; 202: 539–546.
Ivatury RR, Rohman M, Nallathambi M. The morbidity of injuries of the extrahepatic biliary system. J Trauma 1985; 225: 967–974.
Thomason RB, Julian JS, Mortellar HC et al. Microscopic hematuria after blunt trauma — Is pyelography necessary? Am Surg 1989; 55: 145–149.
Mee SL, McAninch JW, Robinson AL et al. Radiographic assessment of renal trauma: A 10 year prospective study of patient selection. J Urol 1989; 141: 1095–1101.
Haas CA, Brown SL, Spirnak JP. Limitation of routine spiral computerized tomography in the evaluation of bladder trauma. J Urol 1999; 162: 51–58.
Carroll PR, Mc Aninch JW. Major bladder trauma: Mechanism of injury and a unified method of diagnosis and repair. J Urol 1984; 132: 254–262.
Referanslar
Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma 1996; 41: 28–33.
Brooks A, Holroyd B, Riley B. Missed injury in major trauma patients. Injury 2004; 35: 407–412.
Goldberg SR, Anand RJ, Como JJ. Prophylactic antibiotic use in penetrating abdominal trauma: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73: S321–S324.
Al-Mulhim AS, Mohammad HA. Non-operative management of blunt hepatic injury in multiply injured adult patients. Surgeon 2003; 1: 81–86.
Fabian TC, Croce MA. Abdominal trauma, including indications for laparotomy, n Mattox LK, Feliciano DV and Moore EE (eds). Trauma. East Norwalk, Appleton & Lange, 2000, 583–602.
Huizinga WK, Baker LW, Mtshali ZW. Selective management of abdominal and thoracic stab wounds with established peritoneal penetration: The eviscerated omentum. Am J Surg 1987; 153: 564–568.
Robin AP, Andrews JR, Lange DA. Selective management of anterior abdominal stab wounds. J Trauma 1989; 29: 1684–1689.
Moore EE, Moore JB, van Duzer-Moore S. Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg 1980; 140: 847–852.
Demetriades D, Velhmahos GC, Comwell EE III. Selective non-operative management of gunshot wounds of the anterior abdomen. Arch Surg 1997; 132: 178–184.
Velmahos CG, Demetriades D, Toutouzas KG et al. Selective non-operative management in 1,856 patients with abdominal gunshot wounds. Should routine laparotomy still be standard of care? Ann Surg 2001; 234: 395–401.
Liu M, Lee C, Veng F. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 1993; 35: 267–277.
McAlvarak MJ, Shaftan GW. Selective conservatism in penetrating abdominal wounds: A continuing re-appraisal. J Trauma 1978; 18: 206–211. Abdominal Trauma 323
Rozycki GS, Ochsner MG, Schmidt JA et al. A prospective study of surgeon performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma 1995; 39: 492–499.
Neugebauer E, Suaerland S. Guidelines for emergency laparoscopy. World J Emerg Surg 2006; 1: 31–36.
Lenworth M Jacobs, Stephen S Luk, in Advanced Trauma Operative Management, 2nd ed. Woodbury, Ciné-Med Publishing, Inc., 2010.
Paddock HN, Tepas JJ, Ramenofsky ML. Management of blunt pediatric hepatic and splenic injury: Similar process, different outcome. Am Surg 2004; 70: 1068–1072.
Fullen WD, Selle JG, Whitely DH et al. Intramural duodenal hematoma. Ann Surg 197; 179: 549–552.
Cogbill TH, Moore EE, Feliciano DV et al. Conservative management of duodenal trauma: A multicenter perspective. J Trauma 1990; 30: 1469–1473.
Shorr RM, Greaney GC, Donovan AJ. Injuries of the duodenum. Am J Surg 1987; 154: 193–199.
Degiannis E, Krawcrykowski D, Velmahos GC et al. Pyloric exclusion in severe penetrating injuries of the duodenum. World J Surg 1993; 17: 751–755.
Cogbill TH, Moore EE, Kashuk JL. Changing trends in the management of pancreatic trauma. Ann Surg 1978; 187: 555–560.
Feliciano DV, Martin JD, Cruse PA et al. Management of combined pancreaticoduodenal injuries. Ann Surg 1987; 205: 670–673.
Mckone TK, Bursch LR, Schoelten DJ. Pancreaticoduodenectomy for trauma: A lifesaving procedure. Am Surg 1998; 54: 361–369.
Bradley EL III, Clements JL Jr, Gonzales AC. The natural history of pancreatic pseudocysts: A unified concept of management. Am J Surg 1979; 137: 135–141.
Wisner DH, Chun V, Blaisdell FW. Blunt intestinal injury: Key to diagnosis and management. Arch Surg 1990; 125: 1319–1326.
Scherk J, Shatney C,Sensaki K et al. The accuracy of computer tomography in the diagnosis of blunt small bowel perforation. Am J Surg 1994; 168: 670–675.
Hackam D, Ali J, Jastaniah S. Effects of other intra-abdominal injuries on the diagnosis, management and outcome of small bowel trauma. J Trauma 2000; 49: 606–610.
Stone HH, Fabian TC. Management of perforating colon trauma: Randomization between primary closure and exteriorization. Ann Surg 1979; 190: 430–441.
Nelson R, Singer M. Primary repair for penetrating colon injuries. Cochrane Database of Systematic Reviews 2003, Issue 3, Art No CD002247. DOI: ID. 1002/14651858.
Ivatury RR, Licata J, Gunduz Y et al. Management options in penetrating rectal injuries. Ann Surg 1991; 57: 57–64.
Ali J. Abdominal trauma with specific reference to hepatic trauma. Can J Surg 1978; 21: 512–517. 324 The Surgical Critical Care Handbook
Feliciano DV, Mattox KL, Jordan GL Jr. Intra-abdominal packing for control of hepatic hemorrhage: A reappraisal. J Trauma 1981; 21: 285–291.
Pachter HL, Knudson MM, Esrig B et al. Status of non-operative management of blunt hepatic injuries in 1995: A multicenter experience with 404 patients. J Trauma 1996; 40: 31–40.
Malhotra AK, Fabian TC, Croce MA et al. Blunt hepatic injury: A paradigm shift from operative to non-operative management in the 1990’s. Ann Surg 2000; 231: 804–810.
Shapiro MB, Jenkins DH, Schwab CW et al. Damage control: Collective review. J Trauma 2000; 49: 969–982.
Moore EE, Thomas G. Orr Memorial lecture: Staged laparotomy for the hypothermia acidosis and coagulopathy syndrome. Am J Surg 1996; 172: 405–412.
Bryan A, Cotton MD, Brigham K et al. Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma 2009; 66: 41–49.
Smith JS, Cooney RN, Mucha P. Non-operative management of the ruptured spleen: A revalidation of criteria. Surgery 1996; 120: 745–751.
Sclafani SJA, Shaftan GW, Scalea TM et al. Non-operative salvage of computed tomography-diagnosed splenic injuries: Utilization of angiography for triage and embolization for hemostasis. J Trauma 1995; 39: 818–826.
Powell M, Courcoulas A, Gardner M et al. Management of blunt splenic trauma: Significant difference between adults and children. Surgery 1997; 122: 654–659.
Francke EL, Neu HC. Post splenectomy infection. Surg Clin North Am 1981; 61: 135–141.
Sheldon GF, Lim RC, Yee ES et al. Management of injury to the porta hepatis. Ann Surg 1985; 202: 539–546.
Ivatury RR, Rohman M, Nallathambi M. The morbidity of injuries of the extrahepatic biliary system. J Trauma 1985; 225: 967–974.
Thomason RB, Julian JS, Mortellar HC et al. Microscopic hematuria after blunt trauma — Is pyelography necessary? Am Surg 1989; 55: 145–149.
Mee SL, McAninch JW, Robinson AL et al. Radiographic assessment of renal trauma: A 10 year prospective study of patient selection. J Urol 1989; 141: 1095–1101.
Haas CA, Brown SL, Spirnak JP. Limitation of routine spiral computerized tomography in the evaluation of bladder trauma. J Urol 1999; 162: 51–58.
Carroll PR, Mc Aninch JW. Major bladder trauma: Mechanism of injury and a unified method of diagnosis and repair. J Urol 1984; 132: 254–262.
