ACİL CERRAHİ GİRİŞİM GEREKTİREN İNCE BARSAK HASTALIKLARI

Yıl 2017, Cilt: 6 Sayı: 2, 83 - 89, 30.06.2017

Erdal Uysal , Hasan Bakır Ahmet Gürer Başar Aksoy

Öz

Çalışmamızda cerrahların günlük pratiklerinde, ince barsakta acil cerrahi girişim gerektiren ana endikasyonları belirlemek, literatür desteğinde verileri analiz etmek amaçlanmıştır. Merkezimizde ince barsak hastalığı nedeniyle acil cerrahi girişim uygulanan 127 hasta çalışmaya alınmıştır. Hastaların dosya ve bilgisayar kayıtları retrospektif olarak incelenerek veriler elde edilmiştir. Hastaların demografik özellikleri, tanıları, yapılan cerrahi girişimler ve mortalite parametreleri kayıt altına alındı.  Elektif opere edilen hastalar ve izole incebarsak hastalığı olmayan hastalar çalışma dışı bırakıldı Rakamsal değişkenler ise ortalama±standart sapma olarak verildi. 

Hastaların ortalama yaşları 50.3±19.2 idi. Kadın erkek oranı 0.58 idi. En sık acil cerrahı girişim 61 (%48) hasta ile ince barsak obstruksiyonu nedeniyle yapıldı. En sık ince barsak obstruksiyonu nedeni olarak adezyonlar bulundu. İnce barsak obstruksiyonlarından sonra en sık acil girişim gerektiren nedenler sırasıyla 28 (%22) hasta ile ince barsak perforasyonları, 18 (%14) hasta mezenter iskemi, 9 (%7) hasta malign neoplaziler ve 8 (%6) hastada chron hastalığına, 3 (%2) hastada benign neoplazmlara bağlıydı. Hastalara en sık yapılan operasyonlar adezyolizis (bridektomi), ince barsak rezeksiyonu ve anastamoz, enterostomi idi. Toplam mortalite sayısı 7 (%5) olarak bulundu. Beş hastada mortalite nedeni mezenter iskemiye bağlı görüldü. Bunu 2 hasta ile ince barsak perforasyonu izledi.

En sık acil cerrahi girişim ince barsak obstrüksiyonları nedeniyle olmaktadır. Obstrüksiyonların en sık sebebi ise postoperative adezyonlardı. İnce barsak perforasyonlarının en sık sebebi künt ve penetran travmalara bağlı perforasyonlardı. Lenfomalar en sık görülen malign ince barsak tümörü olarak bulundu. Akut mezenter iskemi en fazla mortalitenin görüldüğü ince barsak hastalığı olarak bulundu. En sık yapılan cerrahi girişim ince barsak rezeksiyon ve anastamozu idi.  

Anahtar Kelimeler

Acil, İnce barsak, Cerrahi, İntestinal Obstrüksiyon, Neoplazi

SMALL BOWEL DISEASES REQUIRING EMERGENCY SURGICAL INTERVENTION

Öz

In our study, it was aimed to determine the main indications requiring emergency surgical interventions in small intestines in daily practices of surgeons, and to analyze the data in parallel with the literature. 127 patients, who underwent emergency surgical intervention in our center due to small intestinal disease, were involved in this study. The data were obtained by retrospectively examining the files and computer records of the patients. Of the patients, demographical characteristics, diagnoses, performed emergency surgical interventions, and mortality parameters were recorded. The electively operated patients and those having no insulated small intestinal disease were excluded. The numeric variables are expressed as mean ±standard deviation.The mean age of patients was 50.3±19.2 years. The portion of females to males was 0.58. The most frequent emergency surgical intervention was the interventions that were performed due to small intestinal obstruction in 61 (48%) patients. The most frequent reason for small intestinal obstruction was found to be the lesions. Following the small intestinal obstruction, other most frequent reasons were small intestinal perforation in 28 (22%) patients, mesentery ischemia in 18 (14%) patients, malign neoplasia in 9 (7%) patients, chron disease in 8 (6%) patients, and benign neoplasms in 3 (2%) patients. The most frequently performed operations were adhesiolysis (bridectomy), small intestine resection and anastomose, and enterostomy, respectively. The total number of mortality was found to be 7 (5%). The cause of mortality was observed to be mesentery ischemia in 5 patients, followed by small intestinal perforation in 2 patients.    The most frequently performed emergency surgical intervention is the operation performed due to small intestinal obstruction. The most frequent cause of obstructions was the postoperative adhesions. The most frequent cause of the small intestinal perforations was the perforations due to blunt and penetrant traumas. Lymphoma was found to be the most frequently seen small intestinal tumor. The acute mesentery ischemia was found to be the small intestinal disease with highest mortality rate. The most frequently performed operation was small intestinal resection and anastomosis. 

Anahtar Kelimeler

Emergencies, Intestine, Small, Surgery, Intestinal Obstruction, Neoplasms

Kaynakça

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