Çocuk Acil Kliniğine Gelen Gastrointestinal Kanamalı 47 Olgunun Retrospektif Değerlendirilmesi

Abstract

Amaç: Gastrointestinal sistem kanaması çocukluk çağında her yaşta karşımıza çıkabilen ve ağızdan anüse kadar her yerinde görülebilen önemli bir çocuk acil sorunudur. Bu çalışmada çocuk acil kliniğimize gastrointestinal kanama ile başvuran hastaların epidemiyolojik ve laboratuvar özelliklerini ve kanamanın etiyolojik nedenlerini araştırmayı amaçladık.

 Gereç ve Yöntem: Çocuk Acil kliniğine başvuran, gastrointestinal kanama tanısı almış 18 yaş altı hastaların, kayıtları ve yatış dosyaları retrospektif olarak incelendi. Hastaların yaş, cinsiyet, geliş yakınmaları, kullandığı ilaçlar, laboratuvar bulguları, aldıkları tanılar, tedavi yöntemleri, endoskopi ve kolonoskopi bulguları incelendi.

Bulgular: Çocuk acil kliniğine son bir yılda başvuran hastaların 47’si gastrointestinal kanama tanısı aldı. Bunların 24’ü (%51,1) üst, 23’ü (%48,9) alt gastrointestinal kanama idi. Hastaların %40,4’ünde (n: 19) hematemez, %14,9’unda (n: 7) melena ve %44,7’sinde (n:21) hematokezya tespit edildi. Melena ile başvuranların istatistiksel anlamlı olarak (p:0,02) en fazla 5 yaş altında (n:4, %57,1) olduğu görüldü. Hastaların 20’sinde (%42,6) ilaç kullanım hikayesi mevcuttu. İlaç kullanım hikayesi olan 20 hastanın 18’nin (%90) istatistiksel anlamlı olarak non-steroid anti-inflamatuar ilaç kullandığı tespit edildi. Helicobacter pylori pozitif tespit edilen 12 hastanın 6’sı (%50) istatistiksel anlamlı olarak gastrit tanısı aldı. Helicobacter pylori pozitif tespit edilen 12 hastanın 6’sının (%50) istatistiksel anlamlı olarak hematemez ile başvurduğu görüldü.

Sonuç: Bu çalışmada gastrit ve peptik ülserin gastrointestinal kanamanın en sık nedenleri olduğu görüldü. Gastrointestinal kanamaları risk faktörlerine göre değerlendirildiği zaman non-steroid anti-inflamatuar kullanımı ve Helicobacter pylori enfeksiyonunun mukozal lezyonlar ile ilişkisi ortaya koyuldu. Bu nedenle hastaların çocuk acil kliniklerinde özenle değerlendirilip yakın izleme alınması aynı zamanda hasta yakınlarının akılcı ilaç kullanımı konusunda bilgilendirilmesi gerekmektedir.

Keywords

• Gastrointestinal sistem; kanama; çocuk acil

Retrospective Evaluation Of 47 Patients With Gastrointestinal Bleeding In Pediatric Emergency Clinic

Abstract

Objective: Gastrointestinal bleeding (GB) is an important emergency problem that can be seen at any age and every part of gastrointestinal system from mouth to anus. In this study, we aimed to investigate demographic, epidemiologic, clinical and laboratory characteristics of patients with GB who admitted to emergency department.

Material and Method: The records of patients <18 years who admitted to pediatric emergency department with GB were reviewed retrospectively. The age, gender, complaints, drug history, laboratory findings, diagnoses, treatment modalities, endoscopy and colonoscopy findings were recorded.

Results: 47 were found to be folllowed up with the diagnosis of GB in our department. 24 (51.1%) of these were upper and 23 (48.9%) lower GB. Hematemesis was detected in 40.4% (n:19), melena in 14.9% (n:7) and hematochezia in 44.7% (n:21) of them. Patients who applied with melena were mostly <5 years (n:4, 57.1%) which was statistically significant.  Twenty of the patients (42.6%) had drug usage history. 18 (90%) were found to use non-steroidal anti-inflammatory drugs. 6 of the 12 Helicobacter pylori positive (50%) patients were diagnosed as gastritis with statistical significance. 6 patients (50%) with positive Helicobacter pylori were found to have a statistically significant complaint of hematemesis.

Conclusion: In this study, gastritis and peptic ulcer were the most common causes of GB. The assessment of GB according to risk factors, revealed that, non-steroidal anti-inflammatory drug usage and Helicobacter pylori infection were associated with mucosal lesions. Therefore, patients admitted to pediatric emergency departments should be evaluated carefully and informed about rational drug usage.

Keywords

• Gastrointestinal system; bleeding; child emergency

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