Karın Travması ve Karın Ağrısı
Özet
Abdominal travma, acil servislerde yüksek morbidite ve mortalite ile ilişkili, hızlı tanı ve müdahale gerektiren klinik durumlardan biridir. Travmanın erken döneminde özgül bulguların silik olması, tanısal gecikmelere ve mortaliteye yol açabilmektedir. Hemodinamik durum, abdominal travmalı hastalarda tanı ve tedavi sürecini belirleyen en önemli faktördür. Travmada Ultrasonografi ile Genişletilmiş Odaklı Değerlendirme (eFAST), hemodinamik olarak instabil hastalarda hızlı cerrahi karar vermede temel bir araçtır. Kontrastlı bilgisayarlı tomografi ise stabil hastalarda solid organ, retroperitoneal ve gastrointestinal yaralanmaların değerlendirilmesinde altın standarttır. Uygun hasta seçimiyle non-operatif izlem güvenli bir seçenek olmakla birlikte, peritonit, devam eden kanama ve hemodinamik instabilite durumlarında acil cerrahi girişim gereklidir. Abdominal travmanın acil serviste etkin yönetimi; travma mekanizmasının doğru analiz edilmesi, seri klinik değerlendirme, uygun görüntüleme yöntemlerinin zamanında kullanımı ve erken hemodinamik stabilizasyon ile mümkündür. Acil tıp hekimlerinin bu süreçteki hızlı ve doğru kararları, abdominal travmaya bağlı önlenebilir ölümlerin azaltılmasında kritik rol oynamaktadır.
Abdominal trauma is a critical condition frequently encountered in emergency departments and is associated with significant morbidity and mortality. The absence of early specific clinical findings in early stages of trauma may result in delayed diagnosis and increased mortality. Hemodynamic status is the most critical determinant in the management of abdominal trauma. Extended Focused Assessment with Sonography for Trauma (eFAST) is essential for rapid assessment and surgical decision-making in unstable patients, while contrast-enhanced computed tomography remains the gold standard imaging modality in hemodynamically stable patients. Although non-operative management is safe in selected cases, emergency surgical intervention is mandatory in the presence of peritonitis, ongoing hemorrhage, or hemodynamic instability. Effective emergency department management of abdominal trauma relies on rapid assessment, appropriate imaging, timely resuscitation, and early multidisciplinary decision-making. Prompt and accurate interventions by emergency physicians play a pivotal role in reducing preventable deaths related to abdominal trauma.
Referanslar
Arenaza Choperena G, Cuetos Fernández J, Gómez Usabiaga V, et al. Abdominal trauma. Radiologia (English Edition). 2023;65 Suppl 1:S32-s41. doi: 10.1016/j.rxeng.2022.09.011
Leenellett E, Rieves A. Occult Abdominal Trauma. Emergency Medicine Clinics of North America. 2021;39(4):795-806. doi: 10.1016/j.emc.2021.07.009.
Laeseke P, Gayer G. An uncommon cause of abdominal pain following blunt abdominal trauma. The British Journal of Radiology. 2012;85(1015):1025-6. doi: 10.1259/bjr/20841300.
Cobb T. Appendicitis following blunt abdominal trauma. The American Journal of Emergency Medicine. 2017;35(9):1386. e5-. e6. doi: 10.1016/j.ajem.2017.06.051.
Gaballah AH, Algazzar M, Kazi IA, et al. The Peritoneum: Anatomy, Pathologic Findings, and Patterns of Disease Spread. Radiographics. 2024;44(8):e230216. doi: 10.1148/rg.230216.
Antoine Micheau. Abdomen and digestive system anatomy illustration [https://doi.org/10.37019/e-anatomy/166969]. Available from: https://www.imaios.com/en/e-anatomy/abdomen-and-pelvis/digestive-system.
Jeffrey D. Kerby. Advanced Trauma Life Support. Chicago: American College of Surgeons (ACS); 2025. p.289-303.
Antony A.Ferroggiaro, O.John MA. Abdominal Trauma. Judith E. Tintinalli (ed.) Tintinalli's Emergency Medicine: A Comprehensive Study Guide. United States: McGraw-Hill Education; 2020. p:1751-1755.
Liu Y, Gao Y, Chen Z, et al. Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis between Blunt and Penetrating Abdominal Trauma: A Multicentric Retrospective Cohort Study. Emergency Medicine International. 2024;2024:5215977. doi: 10.1155/2024/5215977.
Sullivan BG, Delaplain PT, Manasa M, et al. An Abdominal Seat Belt Sign is Associated With Similar Incidence of Hollow Viscus Injury but Increased In-Hospital Mortality in Older Adult Trauma Patients: A PCSA Multicenter Study. American Surgeon. 2024;90(11):2840-7. doi: 10.1177/00031348241256084.
Quílez Trasobares N, Chicote Carasa Y, Barea Mendoza JA, et al. Seat-belt injuries: clinical presentation and need for surgery. Emergencias. 2023;35(4):315-7. doi: 10.55633/s3me/E052.2023.
Shakargy JD, Gendler S, Talmy T, et al. Blast Injury Patterns Among Israel Defense Forces Fatalities. Military Medicine. 2023;188(7-8):e1788-e94. doi: 10.1093/milmed/usac280.
Varma D, Brown P, Clements W. Importance of the Mechanism of Injury in Trauma Radiology Decision-Making. Korean Journal of Radiology. 2023;24(6):522-8. doi: 10.3348/kjr.2022.0966.
Yale SH, Tekiner H, Yale ES. Origin of Kehr Sign in Traumatic Splenic Trauma. Journal of College of Physicians and Surgeons Pakistan. 2023;33(3):360-1. doi: 10.29271/jcpsp.2023.03.360.
Achatz G, Schwabe K, Brill S, et al. Diagnostic options for blunt abdominal trauma. European Journal of Trauma and Emergency Surgery. 2022;48(5):3575-89. doi: 10.1007/s00068-020-01405-1.
Savoia P, Jayanthi SK, Chammas MC. Focused Assessment with Sonography for Trauma (FAST). Journal of Medical Ultrasound. 2023;31(2):101-6. doi: 10.4103/jmu.jmu_12_23.
C.Hacking. Pediatric eFAST - multiple positive cases. 13 Oct 2024. https://doi.org/10.53347/rID-197769. [Available from: https://radiopaedia.org/cases/197769.
Smyth L, Bendinelli C, Lee N, et al. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World Journal of Emergency Surgery. 2022;17(1):13. doi: 10.1186/s13017-022-00418-y.
Prashant Mudgal. Shattered spleen. 1 Dec 2013. https://doi.org/10.53347/rID-26138. [Available from: https://radiopaedia.org/cases/26138.
Prudovsky I, Kacer D, Zucco VV, et al. Tranexamic acid: Beyond antifibrinolysis. Transfusion. 2022;62 Suppl 1:S301-s12. doi: 10.1111/trf.16976.
Barrett WJ, Kaucher KA, Orpet RE, et al. Tranexamic acid in trauma: A joint position statement and resource document of NAEMSP, ACEP, and ACS-COT. Journal of Trauma and Acute Care Surgery. 2025;99(3):357-63. doi: 10.1097/TA.0000000000004727.
Ali A, Gruen RL, Bernard SA, et al. Tranexamic Acid Timing and Mortality Impact After Trauma. Annals of Emergency Medicine. 2026;87(1):83-9. doi: 10.1016/j.annemergmed.2025.06.609.
De Simone B, Chouillard E, Podda M, et al. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World Journal of Emergency Surgery. 2024;19(1):18. doi: 10.1186/s13017-024-00537-8.
Polomano RC, Fillman M, Giordano NA, et al. Multimodal Analgesia for Acute Postoperative and Trauma-Related Pain. Ameican Journal of Nursing. 2017;117(3 Suppl 1):S12-s26. doi: 10.1097/01.NAJ.0000513527.71934.73.
Harvin JA, Albarado R, Truong VTT, et al. Multi-Modal Analgesic Strategy for Trauma: A Pragmatic Randomized Clinical Trial. Journal of the American College of Surgeons. 2021;232(3):241-51.e3. doi: 10.1016/j.jamcollsurg.2020.12.014.
Joshi GP. Rational Multimodal Analgesia for Perioperative Pain Management. Current Pain and Headache Reports. 2023;27(8):227-37. doi: 10.1007/s11916-023-01137-y.
Referanslar
Arenaza Choperena G, Cuetos Fernández J, Gómez Usabiaga V, et al. Abdominal trauma. Radiologia (English Edition). 2023;65 Suppl 1:S32-s41. doi: 10.1016/j.rxeng.2022.09.011
Leenellett E, Rieves A. Occult Abdominal Trauma. Emergency Medicine Clinics of North America. 2021;39(4):795-806. doi: 10.1016/j.emc.2021.07.009.
Laeseke P, Gayer G. An uncommon cause of abdominal pain following blunt abdominal trauma. The British Journal of Radiology. 2012;85(1015):1025-6. doi: 10.1259/bjr/20841300.
Cobb T. Appendicitis following blunt abdominal trauma. The American Journal of Emergency Medicine. 2017;35(9):1386. e5-. e6. doi: 10.1016/j.ajem.2017.06.051.
Gaballah AH, Algazzar M, Kazi IA, et al. The Peritoneum: Anatomy, Pathologic Findings, and Patterns of Disease Spread. Radiographics. 2024;44(8):e230216. doi: 10.1148/rg.230216.
Antoine Micheau. Abdomen and digestive system anatomy illustration [https://doi.org/10.37019/e-anatomy/166969]. Available from: https://www.imaios.com/en/e-anatomy/abdomen-and-pelvis/digestive-system.
Jeffrey D. Kerby. Advanced Trauma Life Support. Chicago: American College of Surgeons (ACS); 2025. p.289-303.
Antony A.Ferroggiaro, O.John MA. Abdominal Trauma. Judith E. Tintinalli (ed.) Tintinalli's Emergency Medicine: A Comprehensive Study Guide. United States: McGraw-Hill Education; 2020. p:1751-1755.
Liu Y, Gao Y, Chen Z, et al. Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis between Blunt and Penetrating Abdominal Trauma: A Multicentric Retrospective Cohort Study. Emergency Medicine International. 2024;2024:5215977. doi: 10.1155/2024/5215977.
Sullivan BG, Delaplain PT, Manasa M, et al. An Abdominal Seat Belt Sign is Associated With Similar Incidence of Hollow Viscus Injury but Increased In-Hospital Mortality in Older Adult Trauma Patients: A PCSA Multicenter Study. American Surgeon. 2024;90(11):2840-7. doi: 10.1177/00031348241256084.
Quílez Trasobares N, Chicote Carasa Y, Barea Mendoza JA, et al. Seat-belt injuries: clinical presentation and need for surgery. Emergencias. 2023;35(4):315-7. doi: 10.55633/s3me/E052.2023.
Shakargy JD, Gendler S, Talmy T, et al. Blast Injury Patterns Among Israel Defense Forces Fatalities. Military Medicine. 2023;188(7-8):e1788-e94. doi: 10.1093/milmed/usac280.
Varma D, Brown P, Clements W. Importance of the Mechanism of Injury in Trauma Radiology Decision-Making. Korean Journal of Radiology. 2023;24(6):522-8. doi: 10.3348/kjr.2022.0966.
Yale SH, Tekiner H, Yale ES. Origin of Kehr Sign in Traumatic Splenic Trauma. Journal of College of Physicians and Surgeons Pakistan. 2023;33(3):360-1. doi: 10.29271/jcpsp.2023.03.360.
Achatz G, Schwabe K, Brill S, et al. Diagnostic options for blunt abdominal trauma. European Journal of Trauma and Emergency Surgery. 2022;48(5):3575-89. doi: 10.1007/s00068-020-01405-1.
Savoia P, Jayanthi SK, Chammas MC. Focused Assessment with Sonography for Trauma (FAST). Journal of Medical Ultrasound. 2023;31(2):101-6. doi: 10.4103/jmu.jmu_12_23.
C.Hacking. Pediatric eFAST - multiple positive cases. 13 Oct 2024. https://doi.org/10.53347/rID-197769. [Available from: https://radiopaedia.org/cases/197769.
Smyth L, Bendinelli C, Lee N, et al. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World Journal of Emergency Surgery. 2022;17(1):13. doi: 10.1186/s13017-022-00418-y.
Prashant Mudgal. Shattered spleen. 1 Dec 2013. https://doi.org/10.53347/rID-26138. [Available from: https://radiopaedia.org/cases/26138.
Prudovsky I, Kacer D, Zucco VV, et al. Tranexamic acid: Beyond antifibrinolysis. Transfusion. 2022;62 Suppl 1:S301-s12. doi: 10.1111/trf.16976.
Barrett WJ, Kaucher KA, Orpet RE, et al. Tranexamic acid in trauma: A joint position statement and resource document of NAEMSP, ACEP, and ACS-COT. Journal of Trauma and Acute Care Surgery. 2025;99(3):357-63. doi: 10.1097/TA.0000000000004727.
Ali A, Gruen RL, Bernard SA, et al. Tranexamic Acid Timing and Mortality Impact After Trauma. Annals of Emergency Medicine. 2026;87(1):83-9. doi: 10.1016/j.annemergmed.2025.06.609.
De Simone B, Chouillard E, Podda M, et al. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World Journal of Emergency Surgery. 2024;19(1):18. doi: 10.1186/s13017-024-00537-8.
Polomano RC, Fillman M, Giordano NA, et al. Multimodal Analgesia for Acute Postoperative and Trauma-Related Pain. Ameican Journal of Nursing. 2017;117(3 Suppl 1):S12-s26. doi: 10.1097/01.NAJ.0000513527.71934.73.
Harvin JA, Albarado R, Truong VTT, et al. Multi-Modal Analgesic Strategy for Trauma: A Pragmatic Randomized Clinical Trial. Journal of the American College of Surgeons. 2021;232(3):241-51.e3. doi: 10.1016/j.jamcollsurg.2020.12.014.
Joshi GP. Rational Multimodal Analgesia for Perioperative Pain Management. Current Pain and Headache Reports. 2023;27(8):227-37. doi: 10.1007/s11916-023-01137-y.
