Stres Ülserleri: Yedi Olguluk Seri

İsmail Kayabalı

TR EN

Stress Ulcers in Critically Ill Patients: A Series of Seven Cases

Abstract

1966–1975 yılları arasında Ankara Üniversitesi Genel Cerrahi Kliniği’nde tedavi edilen yedi hastanın stres ülserleri retrospektif olarak incelendi. Yaşları 24–52 arasında değişen (ortalama 39) altı erkek ve bir kadın, karın travması, önceki cerrahi girişimler, sepsis veya steroid tedavisi gibi büyük kritik stres etkenlerini takiben akut kanamalı gastroduodenal ülserler geliştirdi. Hepsi üst gastrointestinal kanamaya bağlı hipovolemik durumla kliniğe başvurdu; yalnızca iki olguda (bir duodenum ülseri, bir hemorajik gastrit) endoskopi veya anjiyografi ile lezyon lokalize edilebildi. Transfüzyon gereksinimi olguların bazısında 30 üniteye kadar çıktı. Dört hasta medikal (nazogastrik dekompresyon, asit supresyon, hacim resüsitasyonu, farmakoterapi) ve üç hasta cerrahi (vagotomi + arter ligasyonu veya drenaj) yöntemlerle tedavi edildi. Buna rağmen yedi hastanın altısı kaybedildi ve toplam mortalite %85 olarak gerçekleşti. Yazarlar, stres ülserlerinin patogenezinde mukozal iskemi, asit-pepsin hipersekresyonu, enfeksiyon ve nörojenik mekanizmaların rol oynadığını; medikal tedavi başarısızlığında gecikmeden subtotal gastrektomi ile vagotominin en etkili müdahale olduğunu vurgulamaktadır.

Keywords

Stres ülserleri, Akut gastroduodenal kanama, Travma, Büyük cerrahi girişim, Mortalite, Cerrahi müdahale, Gastroduodenal ülserler

Stres Ülserleri: Yedi Olguluk Seri

Abstract

This retrospective series reviews seven patients treated for stress-related gastrointestinal ulcers at Ankara University Surgical Clinic between 1966 and 1975. Six men and one woman, aged 24 to 52 (mean 39), developed acute bleeding ulcers after major stressors including blunt abdominal trauma, prior abdominal operations, sepsis, or steroid therapy. All presented with ongoing upper GI hemorrhage unresponsive to initial measures; endoscopic or radiologic localization was possible in only two cases (one duodenal ulcer, one hemorrhagic gastritis). Transfusion requirements were extreme, reaching up to 30 units of blood in the most severe case. Four patients underwent aggressive medical management—nasogastric decompression, acid suppression, volume resuscitation, and pharmacologic therapies—while three required surgical intervention (vagotomy with arterial ligation or drainage). Despite these efforts, six of seven patients died, yielding an overall mortality of 85%. The authors discuss pathophysiologic mechanisms—mucosal ischemia, acid-pepsin hypersecretion, infection, and neurogenic factors—and highlight the critical need for early recognition. They conclude that if medical therapy fails, prompt definitive surgery (subtotal gastrectomy with vagotomy) offers the best chance to control hemorrhage and reduce recurrence.

Keywords

Stress ulcers, Acute gastroduodenal bleeding, Trauma, Major surgery, Sepsis, Steroid therapy, Gastroduodenal ulcers, Surgical intervention, Mortality, Medical management

References

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Details

Primary Language

English

Subjects

General Surgery

Journal Section

Research Article

Authors

İsmail Kayabalı This is me
Türkiye

Publication Date

September 30, 1975

Submission Date

July 1, 1975

Acceptance Date

September 30, 1975

Published in Issue

Year 1975 Volume: 28 Number: 3-4

IZ

https://izlik.org/JA48ZK25FK

APA

Kayabalı, İ. (1975). Stres Ülserleri: Yedi Olguluk Seri. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 28(3-4), 603-612. https://izlik.org/JA48ZK25FK

AMA

1.Kayabalı İ. Stres Ülserleri: Yedi Olguluk Seri. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1975;28(3-4):603-612. https://izlik.org/JA48ZK25FK

Chicago

Kayabalı, İsmail. 1975. “Stres Ülserleri: Yedi Olguluk Seri”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 28 (3-4): 603-12. https://izlik.org/JA48ZK25FK.

EndNote

Kayabalı İ (September 1, 1975) Stres Ülserleri: Yedi Olguluk Seri. Ankara Üniversitesi Tıp Fakültesi Mecmuası 28 3-4 603–612.

IEEE

[1]İ. Kayabalı, “Stres Ülserleri: Yedi Olguluk Seri”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 28, no. 3-4, pp. 603–612, Sept. 1975, [Online]. Available: https://izlik.org/JA48ZK25FK

ISNAD

Kayabalı, İsmail. “Stres Ülserleri: Yedi Olguluk Seri”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 28/3-4 (September 1, 1975): 603-612. https://izlik.org/JA48ZK25FK.

JAMA

1.Kayabalı İ. Stres Ülserleri: Yedi Olguluk Seri. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1975;28:603–612.

MLA

Kayabalı, İsmail. “Stres Ülserleri: Yedi Olguluk Seri”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 28, no. 3-4, Sept. 1975, pp. 603-12, https://izlik.org/JA48ZK25FK.

Vancouver

1.İsmail Kayabalı. Stres Ülserleri: Yedi Olguluk Seri. Ankara Üniversitesi Tıp Fakültesi Mecmuası [Internet]. 1975 Sep. 1;28(3-4):603-12. Available from: https://izlik.org/JA48ZK25FK

Stress Ulcers in Critically Ill Patients: A Series of Seven Cases

Abstract

Keywords

Stres Ülserleri: Yedi Olguluk Seri

Abstract

Keywords

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

IZ

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