Kolon Volvuluslarının Tedavisinde Mortaliteyi Etkileyen Nedenler

Year 2016, , 245 - 260, 15.08.2016

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

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

Abstract

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. 

Keywords

volvulus, mortalite

Causes Affecting Mortality in Colonic Volvulus Surgery

Abstract

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.

Keywords

volvulus, mortality

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