Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES最新文献

Background: This study aims to evaluate the impact of traumatic lens injury on visual and anatomical prognosis in open globe injuries (OGI).

Methods: The medical charts of patients with OGIs treated at a tertiary ocular trauma referral center between November 2016 and January 2025 were retrospectively reviewed. Patients were categorized into two groups: those with lens injury (LI) and those without lens injury (NLI). Primary outcome measures were final best-corrected visual acuity (BCVA), functional visual success (BCVA ≥ 0.1 [decimal]), and globe survival. Multivariate logistic regression analyses were utilized to model independent predictors of functional visual success and globe survival. Predictor variables were selected based on clinical relevance and prior trauma literature: lens injury, Zone 3 involvement, injury type, number of surgeries, and initial retinal detachment.

Results: A total of 98 eyes were included in the study; 73 eyes had LI, while 25 eyes did not. Eyes with LI had significantly poorer initial BCVA (mean logMAR 2.33 vs. 1.76; p=0.003) and more frequently sustained Zone 1 injuries (p<0.001). Final BCVA (logMAR 1.62 vs. 1.00; p=0.022), functional visual success (23.3% vs. 60.0%; p=0.002), and globe survival (63.0% vs. 88.0%; p=0.037) were all significantly lower in the LI group. In the multivariable analysis, lens injury independently reduced the likelihood of functional visual success (adjusted OR 0.40; 95% CI 0.11-0.81; p=0.019), whereas it was not an independent determinant of globe survival. The presence of initial retinal detachment was the strongest adverse factor for both functional visual success (adjusted OR 0.07; 95% CI 0.02-0.44; p<0.001) and globe survival (adjusted OR 0.13; 95% CI 0.04-0.40; p<0.001).

Conclusion: Traumatic lens injury independently predicts poorer functional visual success following OGIs. Retinal detachment at presentation remains the most influential determinant of both visual and anatomical prognosis and holds critical importance in trauma management. Incorporation of lens injury into ocular trauma prognostic scoring systems may improve their predictive accuracy.

Although pancreaticoduodenal injuries are rare, they represent complex surgical conditions associated with high risks of morbidity and mortality. This case report presents an emergency pancreaticoduodenectomy (Whipple procedure) performed on a 17-year-old male patient who was admitted to the emergency department following a non-vehicular traffic accident. Imaging studies revealed free intraperitoneal air and fluid, as well as multiorgan injury, including right renal perfusion loss. Emergency surgical exploration revealed a Grade V pancreatic head avulsion, distal bile duct injury, duodenal laceration, a laceration in the proximal one-third of the transverse colon, and right renal devascularization. Considering the patient's intraoperative hemodynamic stability, a Whipple procedure, segmental colectomy with primary anastomosis, and right nephrectomy were performed. On postoperative day 11, a leak developed at the colocolonic anastomosis site, and the patient underwent emergency surgery involving a right hemicolectomy and end ileostomy. During the follow-up period, no additional emergency surgical intervention was required from a general surgery perspective. This case highlights the importance of multidisciplinary team collaboration and individualized surgical decision-making in the management of high-risk trauma based on the patient's clinical condition. In the presence of complex anatomical injuries, determining appropriate surgical timing, selecting optimal techniques, and managing complications play decisive roles in treatment success. In this context, the surgical approach and timing are discussed in light of the current literature and evaluated in comparison with similar cases.

Background: Acute biliary pancreatitis (ABP) is an acute inflammation of the pancreas that can vary in severity, potentially leading to life-threatening complications. Early identification of severe cases is crucial for effective management and improved outcomes. Traditional scoring systems, such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Ranson, are commonly used to assess severity but can be complex and time-consuming. This study aims to assess the reliability of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as accessible biomarkers for predicting ABP severity and to evaluate their relationship with disease severity as determined by the Balthazar grade.

Methods: This retrospective study analyzed 161 patients diagnosed with acute biliary pancreatitis. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio values were compared with ABP severity as assessed by the Balthazar grade. The correlation between these inflammatory biomarkers and disease severity was examined. The study was approved by the Ümraniye Training and Research Hospital Clinical Research Ethics Committee (approval date: 13.03.2025, approval number: 54) and was conducted in accordance with the Declaration of Helsinki.

Results: Elevated NLR and PLR values were significantly associated with increased ABP severity. Both NLR and PLR demonstrated potential as reliable biomarkers for early risk stratification, particularly in resource-limited settings.

Conclusion: NLR and PLR may serve as valuable biomarkers in predicting ABP severity, facilitating early clinical decision-making, particularly in settings where advanced imaging is limited. This study also highlights the clinical relevance of these biomarkers within Türkiye, potentially guiding future updates to pancreatitis management protocols.

Aortoesophageal fistula (AEF) is a rare and life-threatening condition that can result from foreign body ingestion, particularly in vulner-able populations with impaired communication, where diagnosis may be delayed. A 26-year-old male with severe autism and limited expressive ability presented to the emergency department with a two-day history of fever and melena. Two hours prior to arrival, hematemesis occurred during an attempt at oral intake. Caregivers reported behavioral changes and a deterioration in his general condition over the preceding 10 days. Diagnostic imaging revealed a large, curved metallic foreign body that had perforated the esophageal wall, traversed the prevertebral space, and appeared to penetrate the thoracic aorta with its tip, leading to mediastinitis and AEF. Despite emergency surgery with cardiopulmonary bypass, the patient succumbed to sepsis and multi-organ failure within 24 hours postoperatively. This case highlights the importance of clinicians considering the possibility of an asymptomatic period following sharp metallic foreign body ingestion, which can lead to severe complications, particularly in patients with communication impairments. The asymptomatic interval can result in significant complications, including luminal erosion, rupture, or the development of a fistula with adjacent structures. Emergency physicians must suspect AEF, especially in patients with a history of foreign body ingestion, when gastrointestinal bleeding is accompanied by signs of severe infection. Timely use of computed tomography (CT) imaging is critical for confirming the diagnosis and determining the need for emergency surgical intervention. This case underscores the necessity of thor-ough evaluation in managing potentially life-threatening foreign body ingestion.

Background: Necrotizing fasciitis (NF) is a rare but serious surgical emergency that progresses rapidly, requires urgent operative intervention, and carries a high mortality rate. Current prognostic scoring systems may have limited predictive power for mortality across different patient groups. The aim of this study was to identify clinical, laboratory, and radiological factors associated with mortality in patients with necrotizing fasciitis. In addition, the study aimed to provide a foundation for the development of a practical prognostic scoring system that could support early risk stratification in clinical practice.

Methods: This retrospective cohort study examined data from 65 patients diagnosed with NF between January 2021 and December 2024. A modified scoring system was created by integrating the Charlson Comorbidity Index and the total body surface area ratio (Samsun Charlson Comorbidity Index, SaCCI). Sarcopenia was assessed using the psoas muscle index. Using receiver operating characteristic (ROC) analysis, the mortality predictive performance of the modified scoring system was calculated and compared with existing systems.

Results: The SaCCI score demonstrated higher prognostic accuracy than existing systems in predicting mortality, achieving the highest discriminatory power with an area under the curve (AUC) of 0.885. Higher SaCCI scores were associated with a significantly increased risk of mortality. Sarcopenia and delayed surgical intervention were also associated with mortality.

Conclusion: The SaCCI score shows promise as an effective tool for predicting early mortality risk in patients with necrotizing fasciitis. The validity of this scoring system, which may inform clinical decision-making, should be confirmed by further multicenter studies.

Background: To date, no study has evaluated the effects of calcium dobesilate on regenerative capacity after partial hepatectomy. Within the scope of this research, we aimed to elucidate the effects of calcium dobesilate (CD) on liver regeneration capacity and antioxidant pathways after partial hepatectomy.

Methods: Thirty-six Sprague Dawley male rats weighing between 250-350 grams were used in the study. All animals underwent partial hepatectomy. The rats were randomly divided into four groups, each consisting of nine rats, as control groups (Groups 1 and 2) and study groups (Groups 3 and 4). Regeneration rate, histopathological parameters, immunohistochemical examination, and the apoptotic index (AI) were measured.

Results: Tissue superoxide dismutase (SOD) levels were statistically significantly higher in the calcium dobesilate study groups compared to controls (p=0.03). Malondialdehyde (MDA) levels were statistically significantly higher in the study groups than in the control groups on both the second and seventh days (p=0.001). The regeneration rate (RR) was higher in the study group compared to the control group on the second day, and this difference was statistically significant (p<0.001). RR was also significantly higher in the study group on the second day compared to the seventh day (p<0.001). According to the Suzuki Scoring System, vacuolization and necrosis were not observed in the study groups (p<0.001 vs. p=0.034, respectively). The apoptotic index was significantly higher in the control groups compared to the study groups (p<0.001), and AI was statistically significantly lower on the seventh day (p=0.006). Ki-67 expression was statistically significantly higher in the groups receiving CD treatment on both the second and seventh days. In the control groups, Ki-67 expression was statistically significantly higher on the seventh day compared to the second day (p=0.006).

Conclusion: This research indicated the effects of calcium dobesilate on improving oxidative damage and liver regeneration in rats undergoing partial hepatectomy. The results of the present study showed that (preoperative-postoperative) CD improves oxidative stress and increases liver regeneration capacity after partial hepatectomy.

Background: This study aimed to investigate whether the level of the fracture line relative to the olecranon fossa influences surgical difficulty, complication rates, and radiological outcomes in pediatric supracondylar humerus fractures (PHSF).

Methods: A retrospective review was conducted of 822 children who underwent surgical treatment for PHSF. Patients were categorized according to the location of the fracture line relative to the apex of the olecranon fossa: high-level (proximal to the fossa, n=163) and low-level (at or distal to the fossa, n=659). High-level fractures were further classified as oblique (n=40) or transverse (n=123), based on the angle between the fracture line and the transepicondylar line. Patient demographics, fracture characteristics, surgical parameters, complications, radiographic findings, and revision rates were analyzed.

Results: There were no significant differences between groups in terms of patient demographics, fracture side, open versus closed fracture status, neurovascular injury, or associated trauma (p>0.1). High-level fractures were significantly more unstable, required longer surgical durations, and showed a greater number of K-wire cortical scars compared to low-level fractures (p<0.05). K-wire configuration, number, and diameter showed no significant differences. Subgroup analysis demonstrated that oblique high-level fractures more often required divergent pin configurations and had significantly higher revision rates compared with transverse high-level fractures (p=0.049 and p=0.004, respectively).

Conclusion: Fractures located proximal to the olecranon fossa are more unstable and technically demanding, resulting in longer operation times and more intraoperative pinning attempts. Among high-level fractures, oblique types are especially prone to technical challenges and increased revision rates, highlighting the importance of fracture morphology in surgical planning.

Blunt abdominal trauma most often results from high-energy mechanisms such as motor vehicle accidents. The spleen and kidneys are the organs most commonly injured in such cases, whereas pancreatic injuries are rare. Concomitant involvement of the pancreas along with splenic and renal injuries is particularly uncommon. We report the successful non-operative management (NOM) of a 24-year-old male patient who sustained grade IV splenic and left renal injuries, a grade II pancreatic injury, and widespread pulmonary contusions following a motorcycle accident. During follow-up, expansion of the retroperitoneal hematoma, perisplenic fluid collection, and left-sided pleural effusion were observed. Interventional radiology procedures, including abdominal and thoracic drainage, were performed. The presence of high levels of amylase and lipase in the abdominal catheter output indicated the development of a pancreatic fistula, for which conservative treatment was initiated. Following catheter repositioning and administration of a somatostatin analogue, the fistula resolved spontaneously. Although left renal atrophy was detected on long-term follow-up, the patient remained clinically stable. This case highlights that even in the presence of multiple high-grade solid organ injuries, favorable outcomes may be achieved without surgical intervention through NOM. Supported by advanced imaging modalities and interventional radiology, NOM represents a safe and effective therapeutic strategy that can minimize surgical complications in hemodynamically stable patients.

Mechanical bowel obstruction due to a giant colonic calculus is an exceedingly rare clinical entity, typically associated with gallstone ileus or migration through a cholecystocolonic fistula. This case report describes the clinical presentation, diagnostic process, and treatment of an 81-year-old male with a history of cholelithiasis who developed acute mechanical large bowel obstruction due to a 5 cm sigmoid colon calculus. The patient, with comorbidities including diabetes mellitus, hypertension, chronic renal failure, prior prostatectomy, and appendectomy, presented with abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the left lower quadrant without rebound or guarding, indicating no evidence of perforation. Laboratory findings showed leukocytosis (white blood cell count [WBC]: 12,000/μL, neutrophil percentage: 85.2%) and elevated C-reactive protein [CRP] (33 mg/L). Non-contrast abdominal computed tomography (CT) revealed a 5 cm calculus in the sigmoid colon, with proximal dilatation, air-fluid levels, and pneumobilia. A prior hepatobiliary ultrasound had documented a 49 mm gallstone, suggesting migration via a cholecystocolonic fistula. Sigmoidoscopy, performed using an Olympus CF-HQ190 colonoscope with tripod grasping forceps, successfully extracted the calculus. Due to the patient's advanced age and significant comorbidities, surgical repair of the cholecystocolonic fistula was not pursued. A follow-up hepatobiliary ultrasound one month post-procedure revealed no residual gallstones. The patient achieved rapid recovery and was discharged the following day. This case is notable for the exceptionally large 5 cm calculus, which is rare compared to the 2-3 cm stones typically reported, and highlights the efficacy of sigmoidoscopy in managing such cases in elderly patients with significant comorbidities.

Background: Vertebral compression fractures of varying severity and morphology may result from trauma and often require the preparation of a forensic medical report. Given the legal implications, accurate measurement of the compression ratio is critical. This study aims to evaluate whether four literature-defined methods for determining compression ratios are consistent with one another and with radiology reports, and to examine whether the choice of method alters the conclusions of forensic medical reports.

Methods: A retrospective review was conducted of forensic reports issued by our Department of Forensic Medicine between June 1, 2014 and June 1, 2024. Forty-two cases met the predefined inclusion criteria. For each vertebral fracture, the compression ratio was calculated using four established methods. Consistency was assessed both among these methods and between each method and the compression ratio documented in the corresponding radiology report. Finally, it was evaluated whether measurement discrepancies would alter the forensic conclusions regarding (1) the effect of the fracture on life functions, (2) permanent weakness or loss of function of one of the senses or organs, and (3) degree of disability.

Results: Agreement among the four measurement methods was weak to moderate, with inconsistency rates of 14.8% to 66.7% compared to radiology reports. Forensic report conclusions varied according to the measurement method.

Conclusion: Method selection significantly influences both calculated compression ratios and the resulting conclusions of forensic reports in vertebral compression fractures. A standardized, universally accepted measurement protocol is therefore required in forensic practice to support fair and consistent legal decisions.