Abdominal Ateşli Silah Yaralanması Nedeniyle Opere Edilen Çocuk Hastaların Klinik Özellikleri: Bir Somali Deneyimi

Amaç: Ateşli silah yaralanmaları dünya genelinde önemli bir morbidite ve mortalite nedenidir. Bu çalışmada Somali'deki tek çocuk cerrahisi kliniğinde abdominal ateşli silah yaralanması nedeniyle opere edilen hastaların klinik özellikleri incelendi. Gereç ve Yöntemler: Bu çalışmada,Somali'deki tek çocuk cerrahisi kliniğine Mayıs 2019 - Temmuz 2021 tarihleri arasında abdominal ateşli silah yaralanması ile getirilen ve opere edilen 42 çocuk hastanınkayıtları retrospektif olarak incelendi. Hastalar yaş, cinsiyet, yaralanma nedeni (ateşli silah veya bombalanma), tedavi, ameliyat bulguları, yaralanan organlar, hastanede kalış süresi ve komplikasyonlar açısından değerlendirildi. Bulgular: Yaşları 3 - 16 arasında değişen (ortanca 10 yıl), 28 (%67) erkek ve 14 (%33) kadın hastaların 30’u (%71) bombalanma, 12’si ise (%29) kurşunlanma sonucu yaralanmıştı. Vakaların 21’inde (%50) tek, 21’inde (%50) birden fazla organ yaralanması saptandı. En sık hasar gören organlar sırasıyla ince bağırsak (n=24), kolon (n=14), karaciğer (n=10) ve böbrekti (n=7). Ortanca yatış süresi yedi gün olarak saptandı. Vakaların 36’sı (%86) serviste, altısı (%14) yoğun bakım ünitesinde takip edildi. Yoğun bakımda takip edilen iki hastanın seyri mortalite ile sonuçlandı. Sonuç: Çalışmamızın sonuçları, Somali’de tek bir çocuk cerrahisi kliniğinde kısa bir zaman dilimi içinde elde ettiğimiz verilerin, çocukların ciddi oranda abdominal ateşli silah yaralanmalarına maruz kaldıklarını ve önemli bir morbidite ve mortalite ile karşı karşıya olduklarını ortaya koymaktadır.

Anahtar Kelimeler:

Ateşli silah yaralanması, çocuk, cerrrahi tedavi, mortalite, komplikasyonlar

Clinical Characteristics of Child Patients Operated for Abdominal Gunshot Injury: A Somali Experience

Aim: Gunshot injuries are an important cause of morbidity and mortality worldwide. We investigated the clinical characteristics of the abdominal gunshot wound patients operated at the only pediatric surgery clinic in Somalia. Materials and Methods: In this study, the records of 42 pediatric patients who were admitted to the only pediatric surgery clinic in Somalia with abdominal gunshot wounds and operated between May 2019 and July 2021 were retrospectively reviewed. Patients were evaluated in terms of age, gender, cause of injury (firearm or bombing), treatment, surgical findings, injured organs, length of hospital stay, and complications. Results: A total of 42 children aged 3 - 16 years (median 10 years), 28 (67%) male and 14 (33%) women, wounded by bombs (30, 71%) or bullets (12, 29%) were included in the study. Twenty one (50%) had single and the other 21 (50%) had multiple intra abdominal organ injury. Most commonly injured organs were small intestines (n=24), large intestines (n=4), liver (n=10) and kidneys (n=7). Median duration of hospitalization was seven days. Thirty six (86%) patients were followed up in the clinic and 6 (14%) in the intensive care unit (ICU). Two of the patients in the ICU did not survive. Conclusion: The results of our study reveal that the data we obtained in a short period of time in a single pediatric surgery clinic in Somalia show that children are exposed to severe abdominal gunshot wounds and face significant morbidity and mortality.

Keywords:

Child, complications, gunshot wounds, mortality, treatment,

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Global Burden of Disease 2016 Injury Collaborators, Naghavi M, Marczak LB, Kutz M, Shackelford KA, Arora M. Global mortality from firearms, 1990-2016. JAMA 2018; 320: 792-814. https://doi.org/10.1001/jama.2018.10060.
Werbick M, Bari I, Paichadze N, Hyder AA. Firearm violence: a neglected "Global Health" issue. Global Health. 2021; 17(1): 120.
Davis JS, Castilla DM, Schulman CI, Perez EA, Neville HL, Sola JE. Twenty years of pediatric gunshot wounds: an urban trauma center's experience. J Surg Res. 2013 ;184(1): 556-60.
Bayouth L, Lukens-Bull K, Gurien L, Tepas JJ 3rd, Crandall M. Twenty years of pediatric gunshot wounds in our community: Have we made a difference? J Pediatr Surg. 2019; 54(1): 160-4.
https://www.hrw.org/world-report/2020/country-chapters/somalia
Slutkin G, Ransford C, Zvetina D. How the Health Sector Can Reduce Violence by Treating It as a Contagion. AMA J Ethics. 2018; 20(1): 47-55.
Fowler KA, Dahlberg LL, Haileyesus T, Gutierrez C, Bacon S. Childhood Firearm Injuries in the United States. Pediatrics. 2017; 140(1): e20163486.
Phillips R, Shahi N, Bensard D, Meier M, Guns, scalpels, and sutures: The cost of gunshot wounds in children and adolescents. J Trauma Acute Care Surg. 2020; 89(3): 558-64.
Senger C, Keijzer R, Smith G, Muensterer OJ. Pediatric firearm injuries: a 10-year single-center experience of 194 patients. J Pediatr Surg. 2011; 46(5): 927-32.
Kaya K, Akgündüz E, Erdem Z, Hilal A. Child deaths due to firearm-related injuries in Adana, Turkey. Niger J Clin Pract. 2021; 24(11): 1645-8.
Chu KM, Ford NP, Trelles M. Providing surgical care in Somalia: A model of task shifting. Confl Health. 2011; 5(1): 12.
Murhega RB, Budema PM, Tshimbombu TN, et al. Firearm injuries among children due to the Kivu conflict from 2017 to 2020: A hospital-based retrospective descriptive cohort study. Afr J Emerg Med. 2022; 12(1): 44-7.
Chamisa I. Civilian abdominal gunshot wounds in Durban, South Africa: a prospective study of 78 cases. Ann R Coll Surg Engl. 2008; 90(7): 581-6.
Çağlayan K, Çelik A, Bala A, Günerhan Y. Kars Devlet Hastanesi’nde ameliyat edilen batına penetran yaralanmalar. J Exp Clin Med. 2010; 27(2): 54-7.
Uludağ M, Yetkin G, Çitgez B, Yener F, Akgün İ, Çoban A. Penetran ince barsak yaralanmalarında ek organ yaralanmasının morbidite ve mortalite üzerine etkisi. Ulusal Travma ve Acil Cerr. Derg. 2009; 15: 45-51.
DuBose J, Inaba K, Teixeira PGR. Selective non-operative management of solid organ injury following abdominal gunshot wounds. Injury. 2007; 38(9): 1084-90.
Arslan MS, Zeytun H, Arslan S. Operative and non-operative management of children with abdominal gunshot injuries. Ulus Travma Acil Cerrahi Derg. 2018; 24(1): 61-5.