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    Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma
    (Springer-Verlag, 2003) Öztürk, H; Önen, A; Otçu, S; Dokucu, AI; Yagmur, Y; Kaya, M; Yücesan, S
    Purpose. Intestinal perforation due to blunt abdominal trauma is rarely seen in children and delayed diagnosis is a major concern. Because the potential risk factors affecting morbidity are not well known, we evaluated whether diagnostic delay increases morbidity in gastrointestinal perforation from blunt abdominal trauma in children. Methods. Twenty-nine children with gastrointestinal perforation caused by blunt abdominal trauma, admitted to our clinic between 1983 and 2001, were retrospectively evaluated by analyzing the relationship between overall morbidity and potential risk factors. Results. There were 23 boys and 6 girls. Most of the injuries were caused by falls and motor vehicle accidents. The jejunum was the most frequent site of perforation followed by the ileum. Simple closure was the most common surgical procedure. Postoperative complications developed in five patients (17%) and included wound infections in two, wound dehiscence in one, and adhesive small bowel obstruction in two. Potential risk factors such as trauma mechanism, the presence of shock on admission, and associated organ injury were not significantly correlated with postoperative complications, whereas a period of delay exceeding 8h and an Injury Severity Score (ISS) exceeding 15 were significantly related to septic complications (P < 0.05). The relative risk of a septic complication developing was higher than 2 for the following risk factors: a fall from a flat-roofed house and a time delay before operative intervention. There were three deaths (10%) in this series, caused by sepsis in two patients and head injury in one. Conclusion. These findings suggest that rapid diagnosis and treatment is important for preventing complications in patients with intestinal perforation caused by blunt abdominal trauma. A delay exceeding 8h and an ISS score exceeding 15 were related to significant septic complications, and falls from flat-roofed houses are an important public safety risk in Turkey.
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    Öğe
    Factors effecting morbidity in typhoid intestinal perforation in children
    (Springer-Verlag, 2002) Önen, A; Dokucu, AI; Çigdem, MK; Özturk, H; Otçu, S; Yücesan, S
    To determine the factors affecting morbidity in patients with typhoid intestinal perforation (TIP), 42 patients who had been operated upon for TIP between 1990 and 2000 were reviewed. The average age was 10.4 years, the male-to-female ratio 2.5/1. The mean interval from admission to operation was 6 h. Twenty-three children had multiple perforations. Primary closure (PC) was performed in 55% of the patients, ileostomy in 26%, and resection with anastomosis (RA) in 19%. Parenteral nutrition (PN) was available for 22 patients for an average of 9 days. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who received PN and in those who underwent ileostomy. None of the patients developed an enterocutaneous fistula. The 2 deaths (4.8%) resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No operative procedure is likely to be the best in all cases; therapy should be individualized. Ileostomy appears to be an effective procedure, particularly in patients with severe abdominal contamination and delayed presentation. The use of PN in addition to standard medical and surgical therapy in patients with TIP may be beneficial.
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    Öğe
    The protective effects of nitric oxide on the contralateral testis in prepubertal rats with unilateral testicular torsion
    (Blackwell Science Ltd, 2000) Dokucu, AI; Öztürk, H; Özdemir, E; Ketani, A; Büyükbayram, H; Yücesan, S
    Objective To investigate histological changes in the contralateral testis of rats with unilateral testicular torsion and the protective effects of nitric oxide (NO) on possible damage. Material and methods Twenty-eight prepubertal male Sprague-Dawley rats were divided into four equal groups. Group 1 underwent a sham operation of the right testis under general anaesthesia. Group 2 underwent a similar operation but the right testis was rotated 720 degrees clockwise for 6 h, maintained by fixing the testis to the scrotum, and saline infused during the procedure. Group 3 underwent similar torsion but L-arginine methyl ester (a precursor of NO) was infused during the procedure. In Group 4, N-G-nitro-L-arginine-methyl ester, a NO synthase inhibitor, was infused separately during the administration of L-arginine methylester and torsion. All the left (untwisted) testes were removed from rats 21 days after surgery and evaluated histologically, assessing seminiferous tubule diameter, loss of sperm and spermatids, loss of germ cell layers, disarray of germ cell layers, rupture of tubules, Leydig cell proliferation and reaction in the ruptured tubules, and oedema. Results There was a significant difference in the indicators of histological damage between groups 2 and 4 and groups 1 and 3, except for the Leydig cell reaction in the ruptured tubules and oedema. The damage was significantly less in group 3 than in groups 2 and 4. Conclusion These results suggest that long-term histopathological changes in the contralateral testes are important after unilateral testicular torsion and that NO has a protective effect on the contralateral testis.