Retrospective assessment of developing liver injuries in children brought to the emergency room due to the blunt abdominal trauma over the past 10 years; a single -center experience.

Yıl 2021, Cilt: 11 Sayı: 5, 679 - 684, 17.09.2021

Mehmet Uysal , Ahmet Aslan

https://doi.org/10.16899/jcm.896175

Öz

OBJECTIVE: In this study it was aimed to evaluate the types of trauma, accompanying solid organ injuries, treatments, and treatment outcomes in children admitted to our clinic in the last 10 years due to blunt liver trauma.
MATERIAL AND METHOD: The data of 47 patients who were involved in liver injuries owing to blunt abdominal trauma between July 2010-May 2020 assessed retrospectively.
RESULTS: There were 30 (63.8%) male, 17 (36.2%) female patients who had carried out with blunt liver injuries between 1-17 (7.8±5.8) years were involved in this study. The induces of these injuries included traffic accidents 29 ( 61.7%), falls from height 12 25.5 %), bicycle accidents 4 (8.5%), objects falling on the body 1(2.1%), and 1(%2.1) after the assault. Twenty-seven (57.4%) of the patients had isolated liver injuries and 20 (42.6%) of other organ injuries.. Liver injuries were 8 patients (17.3%) stage I, 12 patients (26%) stage II, 18 patients (38.2%) stage III, 8 patients (17%) stage IV, 1 patient (2%) stage V. While all patients of stage I and II were treated conservatively, 4 patients (22.2%) who underwent surgery were stage III, 3 patients (37.5%) were stage IV and 1 patient (100%) were stage V. There was an additional ileum perforation in 2 patients in stage III and 1 patient in stage IV who underwent surgery. Thirty-nine patients (83%) were carrıed out by conservatively in these series of liver injury, whereas eight patients (17%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and the number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were particularly lower in surgically conducted patients.
CONCLUSION: Conservative treatment method should be chosen in patients with a liver injury who have stable hemodynamics after blunt trauma. The shorter duration of hospital stay, less blood transfusion requirement, and lower morbidity and mortality rates are important reasons for this method to be preferred.

Anahtar Kelimeler

trauma, liver, children, injury

Son 10 yılda künt karın travması nedeniyle acil servise getirilen çocuklarda gelişen karaciğer hasarının geriye dönük değerlendirilmesi; Tek merkez deneyimi.

Öz

Son 10 yılda künt karın travması nedeniyle acil servise getirilen çocuklarda gelişen karaciğer hasarının geriye dönük değerlendirilmesi; Tek merkez deneyimi.
Mehmet Uysal1,
1Karaman Devlet Hastanesi, Çocuk Cerrahisi Anabilim Dalı, Karaman, Türkiye
AMAÇ: Bu çalışmada son 10 yılda künt karaciğer travması nedeniyle kliniğimize başvuran çocuklarda travma tipleri, eşlik eden solid organ yaralanmaları, tedavileri ve tedavi sonuçlarının değerlendirilmesi amaçlandı.
GEREÇ VE YÖNTEM: Temmuz 2010-Mayıs 2020 tarihleri arasında künt karın travması nedeniyle karaciğer yaralanması nedeniyle tutulan 47 hastanın verileri geriye dönük olarak değerlendirildi.
BULGULAR: Çalışmaya 1-17 (7,8 ± 5,8) yıl arasında künt karaciğer yaralanması ile başvuran 30 (% 63,8) erkek, 17 (% 36,2) kadın hasta dahil edildi. Bu yaralanmaların nedenleri arasında trafik kazaları (29,% 61,7), yüksekten düşme (12,% 25,5), bisiklet kazaları (4,% 8,5), vücuda düşen nesneler (1,% 2,1) ve 1 (% 2,1) ) saldırıdan sonra. Hastaların 27'si (% 57,4) izole karaciğer yaralanması ve 20'si (% 42,6) diğer organ yaralanmaları idi. Karaciğer yaralanmaları 8 hasta (% 17,3) evre I, 12 hasta (% 26) evre II, 18 hasta ( % 38,2) evre III, 8 hasta (% 17) evre IV, 1 hasta (% 2) evre V. Evre I ve II'deki tüm hastalar konservatif olarak tedavi edilirken, cerrahi uygulanan 4 hasta (% 22,2) evre III, 3 hastalar (% 37,5) evre IV ve 1 hasta (% 100) evre V idi. Evre III' te 2, evre IV'te ameliyat edilen 1 hastada ek ileum perforasyonu vardı. Bu karaciğer hasarı serilerinde otuz dokuz hasta (% 83) konservatif olarak tedavi edilirken, vital bulguları stabil olmayan 8 (% 17) hastaya ameliyat yapıldı. Cerrahi tedavi gören hastalarda ölüm oranı, yoğun bakım ve hastanede kalış süresi ve kan transfüzyonu sayısı daha yüksek iken, hemoglobin düzeyi ve kan basıncı cerrahi olarak uygulanan hastalarda özellikle daha düşüktü.
SONUÇ: Künt travma sonrası hemodinamisi stabil olan karaciğer yaralanmalı hastalarda konservatif tedavi yöntemi seçilmelidir. Hastanede kalış süresinin daha kısa sürmesi, daha az kan transfüzyonu gerektirmesi ve daha düşük morbidite, mortalite yüzdeleri bu yöntemin önemli tercih sebebidir.

Anahtar Kelimeler

travma,, karaciğer, çocuklar, yaralanma

Kaynakça

• 1. Brillantino A, Iacobellis F, Festa P, Mottola A, Acampora C, Corvino F, et al. Non-operative management of blunt liver trauma: safety, efficacy, and complications of a standardized treatment protocol.Bull Emerg trauma.2019; 7(1):49-54
• 2. Richardson JD, Franklin GA, Lukan KJ, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000; 32:324–30.
• 3. Lucas CE, Ledgerwood AM. Changing times and the treatment of the liver injury. Am Surg 2000;66:337–41.
• 4. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000;231:804-13. 5. Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Blunt hepatic injury: minimal intervention is the policy of treatment. J Trauma 2000;49:722-8
• 6. Anadol AZ, Topgül K, Güngör B, Bilgin M, Kesim M. Künt karaciğer travmalarına konservatif yaklaşım. Ulus Travma Acil Cerrahi Derg 2007;13:222-6.
• 7.Coccolini F, Catena F, Moore EE, et al..WSES classification and guidelines for liver trauma. World J Emerg Surg. 2016; 10 (11):50. E Collection 2016.
• 8.Gross M, Lynch F, Canty T Sr, Peterson B, Spear R. Management of pediatric liver injuries: a 13-year experience at a pediatric trauma center. J Pediatr Surg 1999;34:811-7.CrossRef
• 9.Keller MS. Blunt injury to solid abdominal organs. Semin Pediatr Surg 2004;13(2):106-11. CrossRef.
• 10. Eppich WJ, Zonfrillo MR. Emergency department evaluation and management of blunt abdominal trauma in children. Curr Opin Pediatr 2007;19:265-9. CrossRef.
• 11.Management and treatment of liver injury in children. Arslan S, Güzel M,. Turan C, Doğanay S, Doğan AB, Aslan A.Ulus Travma Acil Cerr Derg 2014;20(1):45-50
• 12.Taylor GA, Sivit CJ. Posttraumatic peritoneal fluid: is it a reliable indicator of intraabdominal injury in children? J Pediatr Surg. 1995;30:1644-8.
• 13.Knudson MM, Lim RC, Oakes DD, et al: Nonoperative management of blunt liver injuries in adults: The need for continued surveillance. J Trauma. 30:1494,1990
• 14.Meredith JW, Young JS, Bowling J, et al: Nonoperative management of blunt hepatic trauma: the exception or the rule? J Trauma. 36:529,1994
• 15. Cywess S, Rode H, Millar AJ et al: Blunt liver trauma in children: Nonoperative management. J Pediatr Surg. 20:14,1985
• 16.Gates JD: Delayed hemorrhage with free rupture complicating the nonsurgical management of blunt hepatic trauma: a case report and review of the literature. J Trauma. 36:572,1994
• 17. Pachter HL, Guth AA, Hofstetter SR, et al: Changing pattern in the management of splenic trauma: The impact of nonoperative management. Ann Surg. 227:708,1998
• 18. Pachter HL, Spencer FC, Hofstetter SR, et al: Significant trends in the treatment of hepatic trauma: Experience with 411 injuries. Ann Surg. 215:492,1992
• 19. Pacher HL, Hofstetter SR: The current status of nonoperative management of 57 adult blunt hepatic injuries. Am J Surg. 169:442,1995
• 20. Pacher HL, Spencer FC, Hofstetter SR: Experience with the finger fracture technique to achieve intra-hepatic hemostasis in 75 patients with severe injuries to the liver. Ann Surg. 197:771,1983
• 21. Burch JM, Ortiz VB, Richardson RJ, et al: Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 215:416,1992
• 22.Powell M, Courcoulas A, Gardner M, et al: Management of blunt splenic trauma: Significant differences between adults and children. Surgery. 122:654,1997
• 23 Celebi F, Balik AA, Polat KY, Yildirgan MI, Böyük A, Oren D. Hepatic injuries. Surgical treatment experience. Ulus Travma Derg 2001;7:185-8.
• 24. Troop B, Fabian T, Alsup B, Kudsk K. Randomized, prospective comparison of open and closed peritoneal lavage for abdominal trauma. Ann Emerg Med 1991;20:1290-2.
• 25. Feliciano DV. Continuing evolution in the approach to severe liver trauma. Ann Surg 1992; 216: 521–3.
• 26. Losty PD, Okoye BO, Walter DP, Turnock RR, Lloyd DA. Management of blunt liver trauma in children. Br J Surg 1997;84:1006–8.
• 27.Parks RW, Chrysos E, Diamond T. Management of liver trauma. Br J Surg 1999;86: 1121-35
• 28. Kepertis C, Zavitsanakis A, Filippopoulos A, Kallergis K. Liver trauma in children: Our experience. J Indian Assoc Pediatr Surg 2008;13:61-3.
• 29. Basaklar AC, Türkyılmaz Z. Abdominal and thoracic trauma. In:Başaklar AC, editor. Bebek ve çocukların cerrahi ve ürolojik hastalıkları. Ankara: Palme Yayincilik; 2006. p. 1015-50.
• 30. Suleman ND, Rasoul HA. War injuries of the chest. Injury. 1985;16:382–384. DOI: 10.1016/0020-1383(85)90049-X. [PubMed] [CrossRef] [Google Scholar]
• 31. Arikan S, Kocakusak A, Yucel AF, Adas G, et al. A prospective comparison of the selective observation and routine exploration method for penetrating abdominal stab wounds with organ or omentum evisceration. J Trauma. 2005;58:526–532. DOI: 10.1097/01.TA.0000152498.71380.3E. [PubMed] [CrossRef] [Google Scholar]
• 32. Monneuse OJ, Barth X, Gruner L, et al. Les plaies pénétrantes de l’abdomen, conduite diagnostique et thérapeutique. À propos de 79 patients. Ann Chir. 2004;129:156–163. doi: 10.1016/j.anchir.2004.01.013. [PubMed] [CrossRef] [Google Scholar]
• 33. Croce M, Fabian T, Spiers S, et al. Traumatic hepatic artery pseudoaneurysm with hemobilia. Am J Surg. 1994;168:235–238. DOI: 10.1016/S0002-9610(05)80193-X. [PubMed] [CrossRef] [Google Scholar]
• 34. Walt AJ, Wilson RF. Management of trauma: pitfalls and practice. Philadelphia: Lea Febiger; 1975. p. 348. [Google Scholar]
• 35. Pearl LB, Trunkey DD. Compartment syndrome of the liver. J Trauma. 1999;47:796–798. DOI: 10.1097/00005373-199910000-00035. [PubMed] [CrossRef] [Google Scholar)
• 36.Letoublon C, Chen Y, Arvieux C, et al. Delayed celiotomy as part of nonoperative management of blunt hepatic trauma. World J Surg.2008;32:1189-93
• 37. Norrman G, Tingstedt B, Ekelund M, Andersson R. Nonoperative management of blunt liver trauma: feasible and safe also in centers with a low trauma incidence. HPB (Oxford) 2009;11:50-6.
• 38. Nellensteijn D, Porte RJ, van Zuuren W, ten Duis HJ, Hulscher JB. Paediatricblunt liver trauma in a Dutch level 1 trauma center. Eur J Pediatr Surg 2009;19:358-6