Ahmet TÜRKOĞLU, Metehan GÜMÜŞ, Zübeyir BOZDAĞ, Hekim KUZU, Yılmaz ZENGİN

Ateşli silahla oluşmuş dalak ve diyafram yaralanması olgusunda planlanmış geç laparoskopi

Torakoabdominal ateşli silah yaralanması (ASY)nda temel tedavi eksplorasyondur. Ancak seçilmiş olgularda konservatif yaklaşımlar giderek yaygınlaşmaktadır. Bu çalışmada geciktirilmiş cerrahi ile tedavi edilen ateşli silahla oluşmuş dalak ve diyafram yaralanmalı hastanın yönetimi sunuldu. ASY nedeniyle başvuran 37 yaşında erkek hastaya yapılan bilgisayarlı tomografide dalak üst polde yaralanma ve sol diyaframda yaralanma gözlendi. Vital bulguları stabil olan hastaya 3 günlük konservatif tedavi sonrası laparoskopik diyafram tamiri yapıldı ve hasta sorunsuz taburcu edildi. Diyafram yaralanmasına dalak yaralanması eşlik ettiği durumlarda acil cerrahi gerekmiyorsa ve hasta stabilse diyafram onarımı ertelenerek gereksiz splenektomi önlenebilir.

A planned delayed laparoscopy in a gunshot injury case with spleen and diaphragmatic damage

The basic treatment of thoracoabdominal gunshot injury is surgery. However, a conservative approach is increasingly becoming widespread in selected cases. In this study, the management of a patient with a spleen and diaphragm damage due to a gunshot injury who treated with delayed surgery was presented. A 37-year-old man was admitted with a gunshot injury and a computed tomography showed splenic and left diaphragmatic injury. His vital signs were stable and after a 3 days of conservative treatment, laparoscopic repair of the diaphragm was performed and the patient was discharged uneventfully. When a diaphragmatic injury is accompanied by splenic injury in the case of the patient is stable and there is no need for emergency surgery, the repair of the diaphragm may be delayed to prevent unnecessary splenectomy.

PDF

___

1. Böyük A, Gümüş M, Önder A, et al. Splenic injuries: factors affecting the outcome of non-operative management. Eur J Trauma Emerg Surg 2012; 38:269-274.
2. Navsaria PH, Nicol AJ, Edu S, et al. Selective Nonoperative Management in 1106 patients with abdominal gunshot wounds: Conclusions on safety, efficacy, and the role of selective CT Imaging in a prospective single-center study. Ann Surg 2014 Sep 1. [Epub ahead of print]
3. Gümüş M, Gümüş H. Yıldırgan İ. Nonoperative treatment of gunshot wound to the liver. MJAU 2002; 34:97-99.
4. Butt MU, Zacharias N, Velmahos GC. Penetrating abdominal injuries: management controversies. Scand J Trauma Resusc Emerg Med 2009;17:19. doi: 10.1186/1757-7241- 17-19.
5. Bozkurt MA, Kalaycı MU, Doğan M, et al. Sol diafram yaralanması tespiti nasıl yapılmalıdır? Genel Tıp Derg 2012;22:121-124.