Sigmoid Kolon Torsiyonu: On Dokuz Olgunun Retrospektif Analizi

Abstract

Amaç: Sigmoid kolon torsiyonu, tanı ve tedavisinde henüz bir konsensusun sağlanamadığı, fakat geç kalındığında yüksek oranda morbidite ve mortalite ile sonuçlanan acil bir durumdur. Bu çalışmanın amacı, kliniğimizde sigmoid kolon torsiyonu nedeniyle takip ve tedavi edilen hastaları inceleyerek insidans ve uygun tedavi yaklaşımını belirlemek idi. Materyal ve Metod: Bu çalışma hastaların retrospektif olarak taranması ile dizayn edildi. Hastaların tanısı fizik muayene, ayakta direkt batın grafisi ve gereği halinde bilgisayarlı tomografi ile konuldu. Resussitasyonu takiben akut batın bulguları olan hastalara acil laparotomi, genel durumu iyi ve stabil olan hastalara ise önce kolonoskopik detorsiyon daha sonra semi-elektif veya elektif şartlarda definitif cerrahi uygulandı. Hastaların demografik verileri, insidansı, kolonoskopik detorsiyon ve uygulanan cerrahinin sonuçları analiz edildi. Bulgular: Çalışma süresi içinde intestinal obstrüksiyon nedeniyle takip edilen 706 hastanın 19’u (%2,7) sigmoid kolon torsiyonu idi. Bunların 13’ü erkek (%68,4), 6’sı (%31,6) kadın olup yaş ortalaması 58.00 ±24 idi. On sekiz hastaya (%94,7) kolonoskopik detorsiyon denendi ve 17’sinde (%94,4) başarılı sonuç elde edildi. Kolonoskopik detorsiyonun başarılı olduğu hastalardan 5’ine semi-elektif, 4’üne ise elektif şartlarda rezeksiyon ve primer anastomoz yapıldı. Detorsiyonun başarılı olmadığı bir hastaya acil ve rektal tüp uygulaması yapılan başka bir hastaya semielektif şartlarda Hartman prosedürü uygulandı. Opere edilen hastaların birinde (%9) nüks görülürken ameliyatı kabul etmeyen 6 hastanın 4’ünde (%66,6) nüks gelişti. Opere edilen hasta grubunda mortalite görülmezken opere edilemeyen hasta grubunda 4 hasta (%50) mortal seyretti. Opere edilmeyen hastalarda nüks ve mortalite istatistiksel olarak anlamlı düzeyde yüksek bulundu (p=0,027, p=0,018 sırasıyla). Sonuç: Sigmoid kolon torsiyonunda akut batın bulguları yoksa ilk girişim olarak kolonoskopik detorsiyon, sonrasında elektif veya semi-elektif şartlarda definitif cerrahi uygun bir yaklaşımdır.

Keywords

• Torsiyon,volvulus,endoskopik detorsiyon

Sigmoid Colon Torsion: Retrospective Analysis of Nineteen Cases

Abstract

Background: Sigmoid colon torsion is an emergency situation for which there is no consensus for diagnosis and treatment. The objective of this study is to determine the incidence and appropriate treatment approach by analyzing patients treated and followed up in our clinic for sigmoid colon torsion. Material and Methods: This study screened patients retrospectively. The patients were diagnosed through physical examination, standing abdominal X-ray, and computerized tomography if required. Following resuscitation, emergency laparotomy was performed for patients with acute abdomen symptoms. Colonoscopic detorsion and semi-elective or elective definitive surgery were performed for stabilized patients. Demographic data, incidence rates, colonoscopic detorsion results, and type of surgery applied were analyzed. Results: This study included a total of 19 patients, 13(68.4%) males and 6(31.6%) females with a mean age of 58.00±24. Colonoscopic detorsion was attempted for 18 patients (94.7%), and successful results were achieved in 17(94.4%). After successful colonoscopic detorsion, semielective resection and primary anastomosis were performed for 5 patients, while elective resection and primary anastomosis were applied for 4 patients. Recurrences were seen in one (9%) of the patients who underwent surgery and in 4(66,6%) of the 6 patients who rejected the surgery. No mortality was seen in the operated patient group, whereas 4 patients (50%) died in the non-operated group. Recurrence and mortality were statistically significantly higher in the non-operated group (p=0.027, p=0.018 , respectively). Conclusion: In cases with no symptoms for acute abdomen, colonoscopic detorsion followed by elective or semi-elective definitive surgery is an appropriate approach for sigmoid colon torsion. Key words: 

Keywords

• Torsion,volvulus,endoscopic detorsion

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