KOLON PERFORASYONU İLE SONUÇLANAN GEÇ TANI KONMUŞ TRAVMATİK DİYAFRAGMA YARALANMASI: BİR VAKA TAKDİMİ

Year 2017, Volume: 24 Issue: 4, 173 - 177, 01.12.2017

Mustafa Soner Özcan , Gökhan Peker Tarık Türk Mehmet Gürdal Öztekin

https://doi.org/10.17343/sdutfd.295606

Abstract

ÖZET

Giriş:
Travmatik diafragma yaralanmaları sık görülmeyen ancak yüksek morbidite ve
mortaliteye neden olabilen bir durumdur. Künt travmatik diyafragma rüptürü en
sık motorlu taşıt kazaları sonucu olmaktadır. Asemptomatik seyreden Travmatik
diyafragma yaralanmaları yıllar sonra diafragma hernisine bağlı
gastrointestinal yada pulmoner sistem semptomları ile karşımıza
çıkabilmektedir.

Vaka:
65 yaşında, geçirilmiş trafik kazası hikayesi olan kadın hasta, ciddi nefes
darlığı ve karın ağrısı şikayeti ile hastanemize başvurdu. Sol hidropnömotoraks
saptandı ve tüp torakostomi uygulandıktan sonra, kapalı sualtı drenaj sistemine
bir hafta sonunda bağırsak içeriğinin gelmesi üzerine, acil sol torakotomi ve
laparotomi yapıldı. Transvers kolon batın içine alınıp nekroze olan kısım rezeke
edildi ve kolostomi açıldı. Hastaya postoperatif dönemde yoğun bakım ünitesinde
9 gün  sepsis durumu ile takip ve tedavi
edildi. Ardından servisteki 20 günlük izlemin ardından sorunsuz taburcu edildi.

Sonuç:
Torakoabdominal yaralanma geçiren hastalarda yapılan tüm radyolojik
incelemelerde bulgu saptanmasa bile, hastalar diafragma yaralanması konusunda
dikkatlice incelenmelidir. Geçikmiş tanı hayatı tehdit eden durumlara yol
açabilir. Dikkatli ve uygun yaklaşımla yüksek morbidite ve mortalite ile seyreden
komplikasyonlar açısından erken tanı konabilir.

ABSTRACT

Introduction:
Traumatic diaphragmatic injuries are uncommon injuries but cause high mortality
and morbidity. Motor vehicle accidents are the most common cause of blunt traumatic
diaphragmatic rupture. After years, asymptomatic patients with Traumatic
diaphragmatic injuries may be presented with gastrointestinal and pulmonary
symptoms due to diaphragmatic hernia.

Case:  65 year-old female patient with a history of
traffic accident was admitted to our hospital with severe dyspnea and abdominal
pain. Left hydropneumothorax was detected. 7 days after the tube thoracostomy
procedure, emergency thoracotomy and laparotomy was performed because of
intestinal contents coming from closed underwater drainage system. The
transverse colon was taken back to abdomen, necrosis area was resected, and
colostomy was opened. The patient with sepsis status was treated and followed 9
days in Intensive Care Unit. Then, 20 days after the follow up in the clinic,
she was discharged without any problems.

Result:
Although there are no findings detected on all radiological examinations in
patients with thoracoabdominal injuries, the patients should be carefully
examined for diaphragmatic injuries. Delayed diagnosis may lead to life
threatening conditions. With careful and appropriate approaches, early
diagnosis may be made for complications with high mortality and morbidity

Keywords

Travmatik Diyafragmatik Yaralanma, Travmatik Diyaframa Hernisi, İntestinal perforasyon, Gecikmiş Tanı

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