Çocuklarda dalak yaralanmalarının geriye dönük değerlendirilmesi: Tek bir merkezde on yıllık deneyim

Yıl 2022, , 139 - 143, 15.01.2022

Mehmet Uysal

https://doi.org/10.16899/jcm.994045

Öz

Amaç: Son on yılda dalak yaralanmaları nedeniyle kliniğimize başvuran çocuklarda dalak ve beraberindeki organ yaralanmalarına neden olan travma nedenlerini, tedavi tiplerini ve tedavi sonuçlarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Haziran 2011-Mayıs 2021 tarihleri arasında künt karın travmasına bağlı dalak yaralanması nedeniyle tedavi edilen 76 (56 erkek,20 kız) hastanın raporları retrospektif olarak incelendi.
Bulgular: Hastaların yaşları 2-17 (8.7±5.4) arasında; 56'sı (%73.7) erkek, 20'si (%26.3) kız idi. Yaralanmaların nedenleri arasında motorlu taşıtla ilgili kazalar (%37,48,7), yüksekten düşme (%21,27,6), spor/engellere çarpma (%14,18,3), karın duvarına bir nesnenin çarpması(%3,3,9), atın tekme atması 1 (%1,3) yer aldı. 42 hastada (%55.3) izole dalak yaralanması mevcutken, 34 hastada (%44.7) başka organ yaralanmaları vardı. Dalak yaralanmaları 9’ unda grade I (%11.8), 18’ inde grade II (23.7.% ), 272 sinde grade III (%35.6), 19’ unda grade IV (%25) ve 3’ünde grade V (%3.9) idi. Hemodinamik instabilite nedeniyle üç hastada (%3.9) splenektomi ve iki hastada (2.6%) incebarsak yaralanması nedeniyle incebarsak onarımı yapıldı. Bu hastaların hiçbiri dalak yaralanmasından ölmedi, ancak hastalarımızdan biri ameliyatsız tedavi sırasında beyin hasarından öldü.
Sonuç: Dalak yaralanması olan ve hemodinamik olarak stabil olan hastalarda konservatif tedavi yöntemleri seçilmelidir. Hastanede kalış süresinin kısalması, kan transfüzyonu gereksiniminin azalması ve morbidite, mortalite yüzdelerinin düşmesi bu yöntemin tercih edilmesinin vazgeçilmez nedenleridir. Dalak travmasının yanısıra diğer organ yaralanmalarının olasılığı düşünülmedir.

Anahtar Kelimeler

travma, çocuklar, dalak, tedavi

Retrospective assesment of spleen injuries in children: Ten years of experience in a single center

Öz

Objective: We aimed to assess the causes of trauma that result in spleen and accompanying organ injuries, management types, and results of management in children referred to our clinic for spleen injuries in the last ten years.
Material and Method: The reports of 76 (56 boys,20 girls) patients managed for spleen injuries owing to blunt abdominal trauma between June 2011 and May 2021 were reviewed retrospectively.
Results: The patients were aged between 2-17 (8.7±5.4) years old; 56 (73.7%) were boys and 20 (26.3%) were girls. Causes of injuries included accidents involving a motorized vehicle (37,48.7%), falls from height (21, 27.6%), sports/bumping into obstacles (14,18.3%), a crash object in the abdomen (3,3,9%), kick from a horse 1(1.3%). Isolated spleen injury was present in 42 patients (55.3%), while 34 patients (44.7%) had other organ injuries. Spleen injuries were grade I in 9 patients (11.8%), grade II in 18 (23.7.%), grade III in 27 (35.6%), grade IV in 19 (25%), and grade V in 3 (3.9%). Splenectomy was performed in three patients (3.9%) owing to hemodynamic instability and small intestine repair owing to a small intestine injury in two patients (2.6%). None of these patients died from splenic injuries, but one of our patients died from brain injury while in nonoperative treatment.
Conclusion: Conservative treatment methods should be chosen in patients with a spleen injury who are hemodynamically stable. The shorter duration of hospital stay, less blood transfusion requirement, and lower morbidity, mortality percentages are indispensable reasons for this method to be preferred. The probability of other organ injuries should be thought of besides splenic trauma.

Anahtar Kelimeler

Trauma, Children, Spleen, Treatment

Kaynakça

• 1. Clemente N, Di Saverio S, et al.: Management and outcome of 308 cases of liver trauma in Bologna Trauma Center in 10 years, Ann Ital Chir, 2011; 82: 351-60.
• 2. Dodgion CM, Gosain A, Rogers A, St Peter SD, Nichol PF, Ostlie DJ. National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol. J Pediatr Surg. 2014;49(6):1004-1008.
• 3. Klimek PM, Lutz T, Stranzinger E, Zachariou Z, Kessler U, Berger S. Handlebar injuries in children. Pediatr Surg Int. 2013;29(3):269–73.
• 4. Arslan S, Guzel M, Turan C, Doğanay S, Kopru M. Management and treatment of splenic trauma in children. Ann Ital Chir,2015;86:30-34.
• 5. Visrutaratna P, Na-Chiangmai W: Computed tomography of blunt abdominal trauma in children. Singapore Med J, 2008; 49 (4): 352.
• 6. McVay MR, Kokoska ER, Jackson RJ et al. Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status. J Pediatr Surg 2008; 43: 1072-1076.
• 7. Juyia RF, Kerr HA. Return to play after liver and spleen trauma. Sports Health.2014;6:239-45.
• 8. Kuzma J, Atua V: Conservative management of splenic injury in the tropics. Tropical doctor, 2008; 38:210-21.
• 9. Wegner S, Colletti JE, Van Wie D: Pediatric blunt abdominal trauma. Pediatry Clin North Am, 2006; 53: 243-56.
• 10. Ardley R, Carone L, Smith S, Spreadborough S, Davies P, Brooks A. Blunt splenic injury in children: the hemodynamic status key to guiding management, a 5-year review of practice in a UK major trauma center. Eur J Trauma Emerg Surg. 2019;45(5):791–9
• 11. Leschied JR, Mazza MB, Davenport MS, Chong ST, Smith EA, Hoff CN, et al. Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline. Pediatr Radiol. 2016; 46(2):229–36.
• 12. Yang K, Li Y, Wang C, Xiang B, Chen S, Ji Y. Clinical features and outcomes of blunt splenic injury in children: a retrospective study in a single institution in China. Medicine. 2017;96(51):e9419.
• 13. Davies DA, Pearl RH, Ein SH: Management of blunt splenic injury in children: Evolution of the nonoperative approach. Journal of Pediatric Surgery, 2009; 44:1005-1008.