Dincer Hilmi Anil, Karaca Mehmet Ruchan, Akkapulu Nezih
Department Of General Surgery, Hacettepe University Faculty Of Medicine, Ankara, Turkey.
Ulus Travma Acil Cerrahi Derg. 2025 Aug;31(8):804-807. doi: 10.14744/tjtes.2025.03633.
Intestinal perforation may occur, albeit rarely, following blunt abdominal trauma. However, there is insufficient data in the literature regarding late-onset intestinal ischemia and perforation observed during hospitalization in patients rescued from under the rubble after earthquakes. The intestinal perforations that occurred in this patient group were defined as 'stress-related intestinal ischemia.' After the two earthquakes measuring 7.8 and 7.5 on the Moment Magnitude Scale that occurred in Türkiye on February 6, 2023, a total of 1261 patients were treated at our hospital. Among these patients, delayed intestinal perforation developed in three cases (0.23%) during their hospitalization for various reasons. Two of the patients had a history of hemodialysis due to acute kidney injury, while one patient had undergone continuous renal replacement therapy. No mesenteric injury was detected in any patient, and the median time between the earthquake and the development of intestinal perforation was 30 days. Two patients underwent small bowel resection and anastomosis, while the other patient underwent subtotal colectomy with end colostomy. The median length of stay in the general surgery ward following abdominal surgery was 12 days, and the median total hospital stay for treatment was 67 days. All patients were successfully discharged after completion of their postoperative treatment. In conclusion, delayed intestinal perforations may occur in multi-trauma patients after earthquakes, especially in those with risk factors such as hemodialysis, major surgeries, and prolonged hospitalizations. Stress-induced intestinal necrosis should be considered in the differential diagnosis of acute abdominal conditions that may develop during extended hospital stays.
钝性腹部创伤后虽很少见，但可能发生肠穿孔。然而，关于地震后从废墟中救出的患者在住院期间观察到的迟发性肠缺血和穿孔，文献中的数据不足。该患者群体中发生的肠穿孔被定义为“应激相关肠缺血”。在2023年2月6日土耳其发生的里氏震级分别为7.8级和7.5级的两次地震后，我院共收治了1261例患者。在这些患者中，有3例（0.23%）因各种原因在住院期间发生了延迟性肠穿孔。其中2例患者因急性肾损伤有血液透析史，1例患者接受了持续肾脏替代治疗。所有患者均未检测到肠系膜损伤，地震与肠穿孔发生之间的中位时间为30天。2例患者接受了小肠切除吻合术，另1例患者接受了结肠次全切除并末端结肠造口术。腹部手术后在普通外科病房的中位住院时间为12天，治疗的中位总住院时间为67天。所有患者术后治疗完成后均成功出院。总之，地震后的多发伤患者可能发生延迟性肠穿孔，尤其是那些有血液透析、大手术和长期住院等危险因素的患者。在延长住院期间可能出现的急性腹部疾病的鉴别诊断中，应考虑应激性肠坏死。
