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Kolon Volvuluslarının Tedavisinde Mortaliteyi Etkileyen Nedenler

Year 2016, Volume: 2 Issue: 2, 245 - 260, 15.08.2016
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. 

References

  • 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.

Causes Affecting Mortality in Colonic Volvulus Surgery

Year 2016, Volume: 2 Issue: 2, 245 - 260, 15.08.2016
https://doi.org/10.30569/adiyamansaglik.424312

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.

References

  • 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.
There are 38 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Article
Authors

Bayram Çolak

Burcu Yormaz This is me

İlhan Ece This is me

Serdar Yormaz This is me

Hüseyin Yılmaz This is me

Mustafa Şahin This is me

Publication Date August 15, 2016
Submission Date May 17, 2018
Acceptance Date July 14, 2018
Published in Issue Year 2016 Volume: 2 Issue: 2

Cite

AMA Çolak B, Yormaz B, Ece İ, Yormaz S, Yılmaz H, Şahin M. Kolon Volvuluslarının Tedavisinde Mortaliteyi Etkileyen Nedenler. ADYÜ Sağlık Bilimleri Derg. August 2016;2(2):245-260. doi:10.30569/adiyamansaglik.424312