KOLON PERFORASYONU İLE SONUÇLANAN GEÇ TANI KONMUŞ TRAVMATİK DİYAFRAGMA YARALANMASI: BİR VAKA TAKDİMİ
ÖZETGiriş: 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
Anahtar Kelimeler:
Travmatik Diyafragmatik Yaralanma, Travmatik Diyaframa Hernisi, İntestinal perforasyon, Gecikmiş Tanı
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- 1. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Annals of surgery. 1993;218(6):783.
- 2. Lopez PP, Arango J, Gallup TM, Cohn SM, Myers J, Corneille M, et al. Diaphragmatic injuries: what has changed over a 20-year period? The American Surgeon. 2010;76(5):512-6.
- 3. Goh BK, Wong AS, Tay K-H, Hoe MN. Delayed presentation of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma. CJEM. 2004;6(04):277-80.
- 4. Toh C, Yeo T, Chua C, Low C. Diaphragmatic injuries: why are they overlooked? Journal of the Royal College of Surgeons of Edinburgh. 1991;36(1):25-8.
- 5. Zarour AM, El-Menyar A, Al-Thani H, Scalea TM, Chiu WC. Presentations and outcomes in patients with traumatic diaphragmatic injury: a 15-year experience. Journal of Trauma and Acute Care Surgery. 2013;74(6):1392-8.
- 6. Chatzoulis G, Papachristos IC, Daliakopoulos SI, Chatzoulis K, Lampridis S, Svarnas G, et al. Septic shock with tension fecothorax as a delayed presentation of a gunshot diaphragmatic rupture. Journal of thoracic disease. 2013;5(5):E195.
- 7. Özgüç H, Akköse Ş, Şen G, Bulut M, Kaya E. Factors affecting mortality and morbidity after traumatic diaphragmatic injury. Surgery today. 2007;37(12):1042-6.
- 8. Morgan B, Watcyn-Jones T, Garner J. Traumatic diaphragmatic injury. Journal of the Royal Army Medical Corps. 2010;156(3):139-44.
- 9. Childress M, Grimes O. Immediate and remote sequelae in traumatic diaphargmatic hernia. Surgery, gynecology & obstetrics. 1961;113:573.
- 10. Pappas-Gogos G, Karfis E, Kakadellis J, Tsimoyiannis E. Intrathoracic cancer of the splenic flexure. Hernia. 2007;11(3):257-9.
- 11. Lu J, Wang B, Che X, Li X, Qiu G, He S, et al. Delayed traumatic diaphragmatic hernia: A case-series report and literature review. Medicine. 2016;95(32).
- 12. Vermillion J, Wilson E, Smith R. Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. Hernia. 2001;5(3):158-60.
- 13. Chen J, Wilson S. Diaphragmatic injuries: recognition and management in sixty-two patients. The American surgeon. 1991;57(12):810-5.
- 14. Voeller G, Reisser J, Fabian T, Kudsk K, Mangiante E. Blunt diaphragm injuries. A five-year experience. The American surgeon. 1990;56(1):28-31.
- 15. Grimes OF. Traumatic injuries of the diaphragm: Diaphragmatic hernia. The American Journal of Surgery. 1974;128(2):175-81.
- 16. Ozkan OV, Semerci E, Yetim I, Davran R, Diner G, Paltaci I. Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report. Cases journal. 2009;2(1):6863.
- 17. Magu S, Agarwal S, Singla S. Computed tomography in the evaluation of diaphragmatic hernia following blunt trauma. Indian Journal of Surgery. 2012;74(4):288-93.
- ISSN: 1300-7416
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 2015
- Yayıncı: Süleyman Demirel Üniversitesi
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