AI Summary & Key Takeaways
AI InsightOutcomes in abdominal vascular injuries due to missile wounds still depend on transportation time and coincident inferior caval vein and abdominal organ injuries.
📌 3 Key Takeaways
Abstract
Objective: Although abdominal vascular injuries due to missile bullets are less common compared to other injuries, they are of great importance because of the high mortality rate. There are many factors affecting the mortality rate such as; transportation time, type of injury, visceral organ damages, amount of blood loss and surgical experience of the medical and surgical team. The aim of this study is to assess the mortality rate of abdominal vascular injury caused by the bullets of rifles when visceral organs injury is associated with vascular injury. Methods: Between 1993-2008, registries in surgery department of the hospitals affiliated to Başkent University were scanned and 27 abdominal vascular injuries of a total of 212 abdominal wound cases were detected. The mean age was 24±12 years (22 men and 5 women). Ages ranged from 12 to 58 years. The cause of injury was a mine explosion and firearm in one patient, and firearms in the others. All cases had vascular injuries. 16 cases had major venous injuries, 6 had major arterial injuries and the remaining 5 cases have major arterial and venous injuries. Results: Fifty-four abdominal organ injuries were determined. Twenty-seven of these 54 patients had abdominal vascular injuries. Only one patients systolic blood pressure was higher than 50 mmHg in the preoperative period. The remaining patients had lower systolic blood pressures. In addition, the blood pressure of ten patients could not be determined during admission to the emergency department. Major venous injuries had the worst preoperative hemodynamics. Twenty-three of 54 patients had liver injury (42.59%), stomach injury in 14 patients (25.92%), right kidney injury in 7 patients (12.96), left kidney injury in 5 patients (9.25%) and multiple organ injuries in 2 patients (3.7%). Eight patients underwent vascular ligation, primary repair was done in 12 patients and graft interposition was done in 7 patients. However, 5 cases died before surgical intervention. Out of 5 deaths, one patient died because of sepsis (postoperative 2nd day), one patient died from VCI laceration, sepsis occurred in one, 1 died from renal venous trauma, 1 from vena porta injury and one from cerebral hemorrhage associated with abdominal vascular injury. The management of inferior caval vein injuries, which are responsible for 60% of all deaths, were the most challenging. Conclusion: Vascular traumas within the abdominal area are fatal clinical conditions and complications. Abdominal aortic injuries have a higher fatality rate than venous injuries. Outcomes in abdominal vascular injuries due to missile wounds still depend on transportation time and coincident inferior caval vein and abdominal organ injuries.
Özet
Amaç: Bu çalışmanın amacı ateşli silahlara bağlı kurşun yaralanmaları sonucunda gelişen karın içi damar yaralanmalarının eşlik ettiği organ yaralanmalarına bağlı mortalite oranlarını değerlendirmektir. Yöntemler: 1993-2008 yılları arasında batına isabet eden kurşun yaralanmalı toplam 212 hasta Başkent Üniversitesi'ne bağlı hastanelerin cerrahi departmanlarına müracaat etmiş olup bu hastaların 27sinde batın içi damar yaralanması mevcuttu. Toplam 27 hastanın (22 erkek ve 5 bayan) ortalama yaşları 24±12 idi (12-58 yaş). Bir hastada yaralanma mayın patlaması ve ateşli silah yaralanması sonucu oluşmuştu, diğer hastalarda yaralanma ateşli silah yaralanmasına bağlı idi. Hastaların hepsinde ateşli silah yaralanmasına bağlı damar hasarı mevcuttu. Vakaların 16 sında büyük ven yaralanması, 6sında büyük arter yaralanması ve diğer 5 vakada ise hem büyük arter hemde büyük ven yaralanması mevcuttu. Bulgular: İkiyüz on iki hastanın 54 ünde batın içi organ yaralanması mevcuttu. Elli dört hastanın 27 sinde organ yaralanmasına ilave olarak damar yaralanması vardı. Hastaların 23ünde karaciğer yaralanması (%42,59), 14ünde mide yaralanması (%25,92), 7sinde sağ böbrek (%12,96), 5inde sol böbrek (%9,25), 2sinde multiple organ (%3,7) yaralanması vardı. Sekiz hastada damar ligasyonu, 12sinde primer tamir operasyonu, 7sinde ise greft interpozisyonu uygulandı. Cerrahi girişimi takiben 5 hasta hayatını kaybetti. Beş hastanın 1 tanesi sepsisden (Postop. 2. gün) ölürken geri kalan 4 hasta aşırı kanamaya bağlı olarak kaybedildi. Ölümlerin %60ına neden olan vena kava inferior yaralanmaları en çok dikkat edilmesi gereken yaralanmalardır. Sonuç: Abdominal bölgede oluşan damar yaralanmaları komplikasyonlarla ve ölümcül olaylarla sonuçlanabilir. Abdominal aort yaralanmaları venöz yaralanmalara göre daha yüksek mortaliteye sahiptir. Abdominal damar yaralanmalarında sonuçlar hala hastanın nakil süresine ilave vena cava inferior ve ilave organ yaralanmasına bağlı olarak değişmektedir.