Özlem TEKŞAM, F. Cahit TANYEL, Tutku SOYER, Özlem BOYBEYİ TÜRER

Emniyet Kemeri Yaralanmasında Görülen Bağırsak Avülsiyonu Tanısında Bilgisayarlı Tomografi Kullanımı: Olgu Sunumu

Emniyet kemeri işareti, emniyet kemeri seyrinde torako-abdominal ekimoz görülmesi olup bağırsak yaralanmalarıyla güçlü bir şekilde ilişkilidir. Burada, çocukluk çağı emniyet kemeri yaralanmalarının tanısında bilgisayarlı tomografinin (BT) kullanımı tartışmak amacıyla bağırsak avülsiyonu olan 11 yaşında bir hasta sunulmuştur. Yüksek hızlı trafik kazası nedeniyle 11 yaşında erkek hasta acil servise getirildi. Araçta hastanın emniyet kemerinin takılı olduğu öğrenildi. Genel durumu iyi olup fizik incelemede, batında hassasiyet ve emniyet kemeri izi şeklinde morluk vardı. Tam kan sayımı, idrar tahlili ve kan biyokimyasını içeren ilk tetkikler normal sınırlardaydı. Akciğer ve batın grafilerinde normal bulgular mevcuttu. Batın ultrasonografisinde sol kadranlarda minimal serbest sıvı vardı. Fizik incelemede batın hassasiyeti olduğundan BT çekildi ve batın fasyasında geniş defekt ve sigmoid kolon bütünlüğünde bozulma tespit edildi. Hasta acil ameliyata alındı ve fasyada defekt, ince ve kalın bağırsakta avülsiyon tespit edildi. Hastanın ameliyat sonrası izlemi sorunsuzdu. Emniyet kemeri yaralanması çocukluk çağının ender görülen bir yaralanma şeklidir ve ciddi bağırsak yaralanmasına neden olabilir. Emniyet kemerine bağlı bağırsak avülsiyonunun tanısı özellikle direk batın grafisinde diafragma altı serbest hava olmadığı durumlarda çelişkili ve zordur. Diğer radyolojik tetkikler fizik inceleme bulguları ile uyumsuz olduğunda tanı için BT yapılması önerilir.

The Role of Computed Tomography in the Diagnosis of Bowel Avulsion in Seat-Belt Injury: Report of a Case

Seat-belt sign (SBS) is the pattern of thoraco-abdominal ecchymosis in distribution of seat-belt and considered tobe strongly associated with intestinal injuries. Herein, an 11-year-old boy who had bowel avulsion was presented todiscuss the use of computed tomography (CT) in the diagnosis of seat-belt injury in children. An 11-year-old boy wasbrought to the emergency room because of high-speed motor vehicle crash. His general condition was good. He hadmild abdominal tenderness and a seat-belt bruising on his belly. The first laboratory examinations, chest and abdominalX-rays revealed normal findings. Abdominal ultrasound showed minimal free fluid. Since physical examination revealedongoing tenderness, CT was performed. A large defect in abdominal fascia and disruption in sigmoid colon integritywere detected in CT. The patient underwent emergent exploration revealing disruption in fascia and avulsion in smalland large intestine. The postoperative course was uneventful. Seat-belt injury is a rare type of pediatric trauma and maycause severe bowel injury. The diagnosis of bowel avulsion due to seat-belt injury can be challenging in the absence offree sub-diaphragmatic air in abdominal X-rays. CT should be performed if other radiologic interventions are not compatible with the physical findings.

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