Contents
30.06.2025.
Professional paper
KOMPLEKSNA PENETRANTNA OŠTEĆENJA UNUTRAŠNJIH ORGANA KOD DECE: HIRURŠKE I SISTEMSKE IMPLIKACIJE
Uvod: Prostreli abdomena predstavljaju ozbiljan oblik penetrantne traume koji često dovodi do višestrukih povreda vitalnih struktura unutar trbušne
šupljine. Zbrinjavanje ovakvih pacijenata zahteva multidisciplinarni pristup, brzu stabilizaciju hemodinamskih parametara i hitnu hiruršku
intervenciju. Ishod zavisi od broja i težine povreda, vremena proteklog do operacije, kao i efikasnosti postoperativne nege.
Prikaz slučaja: Prvi pacijent, muškarac star 36 godina, primljen je nakon prostrelne povrede trbuha zadobijene vatrenim oružjem iz neposredne
blizine. Pri prijemu bio je konfuzan, tahikardan (HR 132/min), hipotenzivan (TA 80/60 mmHg), sa rigidnim abdomenom i izraženim znakovima
akutnog abdomena. Urađena je brza reanimacija uz nadoknadu tečnosti i krvi, nakon čega je sprovedena hitna medijalna laparotomija.
Intraoperativno su pronađene višestruke perforacije jejunuma, aktivno krvarenje iz mezenterijalnih sudova i hematoperitoneum sa više od 1500 ml
krvi. Izvršena je resekcija segmenta tankog creva u dužini od 80 cm sa termino-terminalnom anastomozom, hemostaza i ispiranje peritonealne
šupljine. Pacijent je postoperativno zbrinut u jedinici intenzivne nege, a oporavak je protekao bez znakova peritonitisa ili fistulacije. Drugi pacijent,
muškarac star 29 godina, takođe je ranjen vatrenim oružjem, ali u stabilnijem opštem stanju. Po prijemu je bio afebrilan, orijentisan, sa bolom
lokalizovanim u desnom kvadrantu abdomena. Laboratorijski su dominirale blaga leukocitoza i povišeni CRP. Ultrazvuk i CT abdomena ukazali su na
prisustvo slobodne tečnosti u abdomenu i vazdušnih mehurića u blizini hepatične fleksure. Indikovana je eksplorativna laparotomija tokom koje je
ustanovljena linearna povreda kapsule desnog jetrenog režnja i jedinstvena perforacija transverzalnog kolona. Izvršena je primarna sutura creva,
hemostaza jetre i postavljanje drenova. Pacijent je lečen antibiotski i parenteralno, sa urednim postoperativnim tokom i otpušten je iz bolnice
devetog dana.
Zaključak: Oba prikazana slučaja potvrđuju značaj individualnog pristupa u zbrinjavanju prostrelnog oštećenja trbušnih organa. Rano prepoznavanje
stepena povrede, adekvatna preoperativna priprema i blagovremena laparotomija doprinose smanjenju smrtnosti i komplikacija. Uvođenje protokola
za upravljanje traumom i dostupnost obučenog hirurškog tima od suštinskog su značaja za ishod lečenja ovih pacijenata.
Ključne reči: penetrantna trauma, resekcija creva, povreda jetre, laparotomija
Zlatan Elek, Mladen Kasalović, Gojko Igrutinović
01.12.2021.
Professional paper
Fournier 's gangrene: Literature review and case report
Fournier's gangrene is a progressive necrotizing bacterial dermo-hypodermitis of the perineum and external genitalia. It represents a secondary polymicrobial infection with an aerobic and anaerobic group of bacteria, which have a synergistic effect in the development of this disease. Fournier's gangrene is an urgent, potentially life-threatening, medical condition that requires a multimodal approach: surgical debridement of the necrotic tissue, resuscitation of the patient, and the application of a broad spectrum of antibiotic therapy. We present the case of a 45-year-old male, referred to our department due to pain and swelling of the perineal region and scrotum, in the initial stage of Fournier's gangrene. The patient was hospitalized, a surgical incision and drainage of the areas affected by gangrene were made, and he underwent surgical treatment of the wound and intensive suppurative therapy for 23 days. After 23 days of hospitalization, the patient was discharged for home treatment with prior suturing of the incisional wounds, with an orderly local status and good general condition. Timely incision, debridement and application of intensive therapy in a condition such as Fournier's gangrene is of crucial importance. In this way, the possibility of potential complications, the progression of local to systemic disease, as well as the percentage of fatal outcome, is reduced.
Aleksandar Jakovljević, Gojko Igrutinović, Nikola Miljković, Mladen Kasalović, Danijela Vićentijević
01.12.2021.
Professional paper
Analysis of the characteristics of traffic trauma
Introduction: It is estimated that an average of 1,308 people die in traffic accidents in the world every day. Traffic accidents are caused by factors of the road, vehicles and the human factor, which occur alone or in combination with other factors in over 90% of cases. Material and methods: The retrospective systematic research included all cases of traffic trauma that were brought to the admission surgical outpatient clinic in the Clinical Hospital Center Kosovska Mitrovica in the period from January 2020 to December 2022. Results: In the observed period, 126 patients were registered. The age of the respondents differs statistically according to gender (p=0.030), and the highest frequency is male (81.8%) in the working population (18-59 years). The age of the subjects showed no statistical association with the types of injuries in traffic trauma (p=0.151). Friday and Saturday are the days with the highest risk (25.3% of injuries), and Sunday is the day with the least number of injuries (3.6%). The lowest number of injuries was recorded from January to May (n=12, 9.5%), and the highest was in the period August to October (n=54, 42.9%). A male patient, 20 years old, an alcoholic, required urgent surgical treatment (splenectomy) due to abdominal injuries. Alcoholism and the age of the subjects did not show statistical significance (p=0.495), and 24.6% of patients had a diagnosis of alcoholism. The age of the subjects showed a statistical association with hospitalization (p=0.004), male gender and age between 18-59 years. Only 2 patients required transport to a highly specialized facility. The fatal outcome showed a statistically significant correlation with the age of the respondent (p=0.016), there was only one patient (between 12-18 hours), a female, 85 years old as a passenger of a motor vehicle. Conclusion: The results of our study indicate a statistically significantly more frequent injury and hospitalization of male patients, that Friday and Saturday are the days of greatest risk and that the fatal outcome occurs in extremely elderly patients. Our findings favour the need to raise public awareness through the media, public actions and forums.
Mladen Kasalović, Aleksandar Jakovljević, Nikola Miljković, Gojko Igrutinović, Milica Milentijević, Aleksandra Milenković
