Curling Ulcer: Burn-Induced Gastrointestinal Ulceration

Year 1970, Volume: 23 Issue: 4, 1176 - 1184, 31.08.1970

Zeki Candar

https://izlik.org/JA68DL62BG

Abstract

Curling ülseri, ağır termal travmayı takiben duodenum ve nadiren mide mukozasında gelişen akut ülserasyondur. 1842’de Curling tarafından tanımlanmış olup, yanığı izleyen 3–7. günler arasında en sık ortaya çıkar. Vak’a oranları %1’den %30’a kadar değişir; ciddiyet, yaş ve otopsi sayısına bağlıdır. Patogenez çok bileşenli olup splanik kan akımı azalması, hemokonsantrasyon, nörojenik bozukluk, sürrenal disfonksiyon, sepsis, mukozal bariyer hasarı ve asid‐peptik etkiler rol oynar. Klinik olarak kanama, perforasyon, karında distansiyon görünse de bazen asemptomatik kalabilir. Teşhis kritik yanık hastalarında güçtür ve genellikle komplikasyonla birlikte konur. Koruyucu olarak antiasit veya H₂‐blokörler, asid supresyonu ve erken enteral beslenme önerilir. Kanama veya perforasyon gelişirse cerrahi müdahale— ülser onarımı veya rekonstrüktif rezeksiyon—gerekir. Erken tanı ve tedaviyle yüksek mortalite azaltılabilir.

Curling Ülseri: Yanık Sonrası Gastrointestinal Ülserasyon

https://izlik.org/JA68DL62BG

Abstract

Curling ulcer is an acute duodenal (and occasionally gastric) ulceration occurring after severe thermal injury. First described by Thomas B. Curling in 1842, these ulcers develop most often in the third to seventh day post‐burn. Reported incidence varies widely—from under 1% to over 30%—depending on burn severity, patient age and autopsy practices. Pathogenesis remains multifactorial, with proposed mechanisms including splanchnic hypoperfusion and hemoconcentration, neurogenic impairment, adrenal dysfunction, sepsis, mucosal barrier disruption and acid‐peptic erosion. Clinically, patients may present with gastrointestinal bleeding, perforation, abdominal distension or may remain asymptomatic. Diagnosis is challenging in critically ill burn patients and often delayed until complications arise. Initial management is conservative—acid suppression, enteral nutrition, avoidance of stressors—and prophylaxis with antacids or H2‐blockers. Persistent or catastrophic hemorrhage and perforation mandate surgical intervention (e.g., oversewing the ulcer or gastric resection). Recognition of this complication and prompt treatment can reduce mortality, which historically has approached 80% in untreated cases.

Keywords

Curling ulcer , duodenal ulcer , burns complications , gastrointestinal ulceration , burn prophylaxis

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