Kolon Volvuluslarının Tedavisinde Mortaliteyi Etkileyen Nedenler

Yıl 2016, Cilt: 2 Sayı: 2, 245 - 260, 15.08.2016

Bayram Çolak Burcu Yormaz İlhan Ece Serdar Yormaz Hüseyin Yılmaz Mustafa Şahin

https://doi.org/10.30569/adiyamansaglik.424312

Öz

Amaç: Kolon volvulusları, kolon
segmentinin kendi mezenteri etrafında dönmesi olarak tanımlanmıştır. Hayatı
tehdit edici olup, kısa sürede tanı konulması ve tedavi edilmesi gerekmektedir.
Çalışmada, volvulus tanısı ile non-operatif veya operatif yöntemlerle tedavi
edilen hastalardaki mortalite ve morbidite nedenleri incelendi.

Gereç ve Yöntem: 2010-2018 tarihleri arasında
acil servisten yatırılarak tedavi edilen ileus hastaları içinden volvulus
tespit edilen hastaların dosyaları geriye dönük değerlendirildi.

Bulgular: Volvulus tanısı ile 155 hasta
incelendi. Hastaların 91’i (%58.7) rezeksiyon ve anastomoz, 37’si (%23.8)
rezeksiyon ve ostomi, 27’si (%17.4) sigmoidoskop ile dekompresyon yapılarak
tedavi edildi. Hastaların 54’ünün (%34.8) ilk değerlendirmede komplike olduğu
tespit edildi. Ameliyata alınan hastaların 33’ünde (%26) iskemik kolon, 21’inde
(%16) perforasyon, 74’ünde (%58) normal batın bulguları ile karşılaşıldı. 92
hastada (%59.3) post operatif dönemde operasyona bağlı komplikasyon gelişti. 33
(%21.2) hastada yattıkları süre içinde mortalite gelişti. Mortalite gelişen
hastaların yaş ortalaması 75.7 idi. Mortalite gelişen hastaların 23’ü (%70)
tekrar operasyon gereken anastomoz kaçağı gelişmiş hastalar ve bu hastaların da
28’i (%85) birden çok ek hastalığı olan hastalar idi. Bu hastaların karın içi
basınç değerleri gözlendiğinde %63.6’sında grade 4 karın içi basınç artışı tespit
edildi. 

Sonuç: 65 yaş üstü, ek hastalıkları
olan (özellikle KOAH), karın içi basınç artışı grade 3 ve üzerinde olan
komplike volvuluslarda, komplikasyon oranlarının yüksek olabileceği ve bu
komplikasyonların da mortalite ile sonuçlanabileceği akılda tutulmalıdır. 

Anahtar Kelimeler

volvulus, mortalite

Causes Affecting Mortality in Colonic Volvulus Surgery

Öz

Aim: Colonic
volvulus can be determined as twistle of its own colon mesenterium. Volvulus threatens
the life and should be diagnosed and treated in a short time. The causes of
mortality and morbidity in patients treated with non-operative or operative methods
with volvulus diagnosis were studied.

Material
and method:
Patients who were diagnosed as volvulus in ileus patients who were hospitalized
and treated between 2010-2018 were retrospectively evaluated.

Results: 155 patients with a diagnosis of
volvulus were viewed. Ninety-one (58.7%) patients were treated with resection and
anastomosis, 37 (23.8%) with resection and ostomy, and 27 (17.4%) with decompression
with sigmoidoscopy. Complicated volvulus was found in 54 (34.8%) patients by the
initial evaluation. 33 patients (26%) had ischemic colonic disease, 21 patients
(16%) had perforation, and 74 patients (58%) had normal clinical findings. operation-related
complications were detected in 92 (%59.3) post operatively. Mortality was detected
in 33 (21.2%) patients during the period they were hospitalized. The meanage of
the patients who found mortality was 75.7%. 23 (70%) of the patients related
with mortality had anastomotic leak requiring reoperations and 28 (85%) of
these patients had multiple comorbidities. Mortality related patients had a
grade 4 intraabdominal pressure increase (63.6%).

Conclusion: It should be kept in mind that the
complication rates may be higher in complicated volvulus with an
over-65-year-old, especially COPD in concomitant diseases, intra abdominal pressure
increase grade 3 and above, and these complications may also result in
mortality.

Anahtar Kelimeler

volvulus, mortality

Kaynakça

• 1. Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010;12(7):1-17.
• 2. Jones DJ. ABC of colorectal diseases. Large bowel volvulus BMJ 1992;305(6849):358-60.
• 3. Mulas C, Bruna M, García-Armengol J, Roig JV. Management of colonicvolvulus. Experience in 75 patients. Rev Esp Enferm Dig 2010;102:239-48.
• 4. Yakan S, Şirinocak A, Telciler K E, Yılmaz S, Deneçli A G. Kolon volvulusları: Süregelen problem ve tedavi seçenekleri. Ege Tıp Derg 2009;48: 89-93.
• 5. Atamanalp SS, Atamanalp RS. The role of sigmoidoscopy in the diagnosis and treatment of sigmoid volvulus. Pak J MedSci.2016;32(1):244-248.
• 6. Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Basoglu M, Polat KY, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primaryResection: Experience with 827 cases. Dis Colon Rectum. 2007;50(4):489-497.
• 7. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984; 199: 28–30.
• 8. Malbrain ML, Cheatham ML, Kirkpatricl A. Et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions Intensive Care Med 2006; 32:1722–1732
• 9. Parsak CK. Komplike abdominal infeksiyonlarda abdominal kompartman sendromu. ANKEM Derg 2012; 26 (ek 2): 337-348.
• 10. Lau KCN, Miller BJ, Schache DJ, Cohen JR. A Study large bowel volvulus in urban Australia. Can J Surg 2006; 49: 203-207.
• 11. Madiba T, Thomson S. The management of caecal volvulus. Dis Colon Rectum 2002;45:264-7.
• 12. Margolin DA, Whitlow CB. The pathogenesis and etiology of colonic volvulus. Semin Colon Rectal Surg 1999; 10:129-38.
• 13. Yaseen ZH, Watson RE, Dean HA, et al. Case report: transverse colon volvulus in a patient with Clostridium difficle pseudomembranous colitis. Am J Med Sci. 1994;308:247-50.
• 14. Rokitansky C. Intestinal strangulation. Arch Gen Med 1837;14:202-204.
• 15. Atamanalp SS. Sigmoid volvulus: Diagnosis in 938 patient sover 45.5 years. Tech Coloproctol. 2013;17(4):419-424
• 16. Atamanalp SS, Kantarci A, Ozogul B, Kisaoglu A, Atamanalp RS. The role of CT and MRI in the diagnosis of sigmoid volvulus. Turk J Med Sci. 2014;44(2):352.
• 17. Catalano O: Computed tomographic appearance of sigmoid volvulus. Abdom Imaging 1996, 21(4):314-317.
• 18. Ott DJ, Chen MYM: Specific acute colonic disorders. Radiol Clin North Am 1994, 32:871-884.
• 19. Young WS, Engelbrecht HE, Stocker A: Plain film analysis in sigmoid volvulus. Clin Radiol 1978; 29:553-560.
• 20. Bhatnagar BNS, Sharma CLN, Gautam A, Kakar A, Reddy DCS. Gangrenous sigmoid volvulus: a clinical study of 76 patients. Int J ColorectalDis 2004; 19: 134-42.
• 21. Arnold GJ, Nance FC. Volvulus of the sigmoid colon. Ann Surg 1973; 177: 527-37.
• 22. Oncu M, Piskin B, Calik A, Yandı M, Alhan E. Volvulus of the sigmoid colon. South Afr J Surg 1991; 29: 48-9.
• 23. Kuzu MA, Aslar AK, Soran A, et al. Emergent resection for acute sigmoid volvulus: results of 106 consecutive cases. Dis Colon Rectum 2002;45:1085-90.
• 24. Hiltunen KM, Syrja H, Matikainen M. Colonic volvulus. Diagnosis and results of treatment in 82 patients. Eur J Surg. 1992; 158: 607-611.
• 25. Grossmann EM, Longo WE, Stratton MD, et al. Sigmoid volvulus in Department of Veterans Affairs Medical Centers. Dis Colon Rectum 2000; 43: 414-418.
• 26. Brothers TE, Strodel WE, Eckhauser FE. et al.Endoscopy in colonic volvulus. Ann Surg 1987;206:1-4.
• 27. Gibney EJ. Volvulus of the sigmoid colon. Surg Gynecol Obstetrics 1991; 173:243-248.
• 28. Akgun Y. Mesosigmoplasty as a definitive operation treatment of acute sigmoid volvulus. Dis Colon Rectum 1996; 39: 579-581.
• 29. Naaeder SB, Archampong EQ. One stage resection of acute sigmoid volvulus. Br J Surg. 1995; 82: 1635-1636.
• 30. Chang JG, Shelton A, Welton ML. In: Volvulus: Dogherty GM, Way LW, Editors. Surgical Diagnosis and treatment. 10th ed. Connecticut Appletonand Lance; 1994. p. 675-7.
• 31. Dulger M, Canturk NZ, Utkan NZ, Gonullu NN. Management of sigmoid colon volvulus. Hepatogastroenterology 2000; 47:1280-3.
• 32. Bhuiyan MM, Machowski ZA, Linyama BS, Modiba MC. Management of sigmoid volvulus in Polokwane-Mankweng Hospital. S Afr J Surg 2005; 43: 17-9.
• 33. Atamanalp SS, Yildirgan MI, Basoglu M, Kantarci M, Yilmaz I. Sigmoid colon volvulus in children: review of 19 cases. Pediatr SurgInt 2004; 20: 492-5.
• 34. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive care medicine2013;39:1190-1206.
• 35. Cheatham ML. Abdominal compartment syndrome. Curr Opin Crit Care 2009;15:154-162.
• 36. Carr JA. Abdominal compartment syndrome: a decade of progress. J Am Coll Surg 2013;216:135-146.
• 37. Ameloot K, Gillebert C, Desie N, Malbrain ML. Hypoperfusion, shock states, and abdominal compartment syndrome (ACS). Surg Clin North Am 2012;92:207-220.
• 38. An G, West MA. Abdominal compartment syndrome: a concise clinical review. Crit Care Med 2008;36:1304-1310.