Journal of Trauma and Injury

  • 제28권2호
  • /
  • Pages.60-66
  • /
  • 2015
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

경운기 사고에 의해 발생한 복부 및 회음부 장기 손상

Abdomino-perineal Organ Injuries Caused by Cultivators

  • 여광희 (부산대학교병원 외상외과) ;
  • 박찬용 (부산대학교병원 외상외과) ;
  • 김호현 (부산대학교병원 외상외과) ;
  • 박순창 (부산대학교병원 응급의학과) ;
  • 염석란 (부산대학교병원 응급의학과)
  • Yeo, Kwang Hee (Division of Trauma Surgery, Trauma Center of Pusan National University Hospital) ;
  • Park, Chan Yong (Division of Trauma Surgery, Trauma Center of Pusan National University Hospital) ;
  • Kim, Ho Hyun (Division of Trauma Surgery, Trauma Center of Pusan National University Hospital) ;
  • Park, Soon Chang (Department of Emergency Medicine, Pusan National University Hospital) ;
  • Yeom, Seok Ran (Department of Emergency Medicine, Pusan National University Hospital)
  • 투고 : 2015.01.26
  • 심사 : 2015.05.15
  • 발행 : 2015.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Cultivator accidents are frequent and often lead to abdomino-perineal organ injury and, if severe, to death. This study presents the clinical characteristics, outcomes, and factors associated with mortality in patients who sustained an abdomino-perineal organ injury in cultivator accidents. Methods: We retrospectively analyzed the records of 53 patients who visited the emergency department of a tertiary hospital with abdomino-perineal organ injuries caused in cultivator accidents from April 2005 to March 2010. Results: All 53 patients had visited other medical institutions before visiting our hospital. Their mean age was $64.0{\pm}11.1$ (range, 20-80) years and 32 (60.4%) patients were 65 or older. The male-to-female ratio was 46:7. The chief complaint was abdominal pain (38 cases, 71.7%). The 53 patients included 41 cultivator operators (77.4%), 11 passengers (20.8%), and 1 passerby (1.9%). The causes of the injuries included a direct impact of the handlebar in 20 cases (37.7%), a rollover in 21 cases (39.6%), a fall in 10 cases (18.9%), and a wheel in two cases (3.8%). Several of the 53 patients had injuries to multiple abdomino-perineal organs, and the injured organs included the liver (23 cases, 26.4%), spleen (16 cases, 18.4%), pancreas (7 cases, 8.0%), small bowel (7 cases, 8.0%), mesentery (6 cases, 6.9%), adrenal gland (5 cases, 5.8%), and other organs. According to the abbreviated injury scale (AIS) dictionary, a thoracic injury was the most frequent co-injury (33 of 53 cases, 62.3%). Abdomino-perineal surgery was performed in 31 cases (58.8%) and angio-embolization was performed for six liver and two kidney injuries. Thirteen patients died (24.5%); all were males. The Injury Severity Scale (ISS) was lower in the survivors ($17.8{\pm}8.5$ vs. $27.0{\pm}16.0$; p=0.010). Conclusion: With the aging of agricultural workers, safety education programs should be implemented. Furthermore, the patient transfer system in agricultural areas must be improved.

키워드

참고문헌

  1. Nam BD, Lee SK. A study on accident of the residents in rural area. Korean J Rural Med 1983; 8: 12-8.
  2. Kim DH, Jung C. Accident and disease related to agriculture in a rural Korea. Korean J Rural Med 1998; 23: 39-49.
  3. Kim BS, Chon HJ, Cah IJ. Farmer's syndrome and the accidents due to agricultural machines of some rural residents. Korean J Rural Med 1993; 18: 93-102.
  4. Kim BS, Chon HJ. A study for injuries due to agricultural machines in Kyeongsangnam province. Korean J Rural Med 1995; 20: 15-23.
  5. Lee KE, Lee HJ, Gwak WG, Ji MG, Song HS, Hong SY, et al. Relationship between reflective light and traffic accidents involving power-tillers. Korean J Rural Med 2003; 28: 61-70.
  6. Park HS, Hong JH, Park PK, Han SK. Investigation on the farm work accidents of the two-wheel tractor in Korea. J Korean Soc Agr Mach 1978; 3: 126-32.
  7. Son MH, Shin JH, Lee MH, Moon G, Sohn SJ, Choi JS, et al. A study on farming tool-machinery injuries in Chonnam province. Korean J Rural Med 1993; 18: 121-9.
  8. Michetti CP, Sakran JV, Grabowski JG, Thompson EV, Bennett K, Fakhry SM. Physical examination is a poor screening test for abdominal-pelvic injury in adult blunt trauma patients. J Surg Res Mar 2010; 159: 456-61. https://doi.org/10.1016/j.jss.2009.04.046
  9. Na YB, Moon HY, Park ST, Ha WS, Choi SK, Hong SC et al. Abdominal Trauma by Cultivators in Rural communities of Western Gyeongsang Southern Province. 2003; 16: 85-90.
  10. D'Errico E, Goffre B, Mazza D. Blunt abdominal trauma: current management. Chir Ital 2009; 61: 601-6.
  11. Badger SA, Barclay R, Campbell P, Mole DJ, Diamond T. Management of liver trauma. World J Surg 2009; 33: 2522-37. https://doi.org/10.1007/s00268-009-0215-z
  12. Sabe AA, Claridge JA, Rosenblum DI, Lie K, Malangoni MA. The effects of splenic artery embolization on nonoperative management of blunt splenic injury: a 16-year experience. J Trauma 2009;67:565-72; discussion 571-2. https://doi.org/10.1097/TA.0b013e3181b17010
  13. Peitzman AB, Ferrada P, Puyana JC. Nonoperative management of blunt abdominal trauma: have we gone too far? Surg Infect (Larchmt) 2009; 10: 427-33. https://doi.org/10.1089/sur.2009.021
  14. Carvalho FH, Romeiro PC, Collaco IA, Baretta GA, Freitas AC, Matias JE. Prognostic factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma. Rev Col Bras Cir 2009; 36: 123-30. https://doi.org/10.1590/S0100-69912009000200006
  15. Ahmed N, Vernick JJ. Pancreatic injury. South Med J 2009; 102: 1253-6. https://doi.org/10.1097/SMJ.0b013e3181c0dfca
  16. Alonso RC, Nacenta SB, Martinez PD, Guerrero AS, Fuentes CG. Kidney in danger: CT findings of blunt and penetrating renal trauma. Radiographics 2009; 29: 2033-53. https://doi.org/10.1148/rg.297095071
  17. Campillo-Soto A, Soria-Aledo V, Renedo-Villarroya A, Millan MJ, Flores-Pastor B, Girela-baena E, et al. Computerised tomography in the diagnosis of intestinal and mesenteric injuries in closed abdominal trauma. Cir Esp 2009; 86: 13-6. https://doi.org/10.1016/j.ciresp.2009.03.016
  18. Rey Valcarcel C, Turegano Fuentes F, Carlin Gatica J, Ruiz de la Hermosa A, Vasquez Jimenez W, Perez Diaz D, et al. Gastrointestinal and mesenteric injuries in the trauma patient: incidence, diagnosis delay and prognosis. Cir Esp 2009; 86: 17-23. https://doi.org/10.1016/j.ciresp.2009.01.015
  19. Yu J, Fulcher AS, Turner MA, Cockrell C, Halvorsen RA. Blunt bowel and mesenteric injury: MDCT diagnosis. Abdom Imaging 2010 (Epub ahead of print)
  20. Schneider R, Moebius C, Thelen A, Jonas S. Duodenal perforation after blunt abdominal trauma. Zentralbl Chir 2009; 134: 567-9. https://doi.org/10.1055/s-0028-1098901