YETİŞKİN BİR OTİSTİKTE METAL TEL YUTULMASINA BAĞLI GELİŞEN AORTA-ÖZEFAGEAL FİSTÜL SONUCU ÖLÜM: BİR OLGU SUNUMU

Öz

Aorta-özefageal fistül nadir görülmesine rağmen üst gastrointestinal kanama nedeniyle ölümcül seyreder. En sık sebebi torasik aort anevrizması iken yabancı cisim yutulması ikinci sıradadır. Olgumuz ailesi tarafından ölü olarak bulunan 43 yaşında bir erkek olup otizm ve epilepsi hastasıdır. Ailesinden edinilen bilgiye göre, olgumuzun zaman zaman böcekleri ağza alma-yeme gibi oral davranış problemleri bulunmaktadır. Aorta-özefageal fistül olgularının birçoğunda göğüs ağrısı primer semptom iken olgumuzun otizme bağlı iletişim kurma problemleri nedeniyle ailesinin dikkatini çekecek herhangi bir semptom tanımlamamıştır. İstanbul Adli Tıp Kurumu Morg İhtisas Dairesi’nde yapılan otopsisinde; özefagus lümeninin arka duvarına ve komşuluğundaki inen aort proksimaline penetre olmuş yaklaşık 0,1cm kalınlığında 9,5cm uzunluğunda yay şeklinde kıvrılmış metal tel tespit edilmiştir. Gelişen fistül nedeniyle özefagus lümeninde ve mide içinde toplam 1500mL koagüle kan tespit edilmiştir. Olgumuz, literatürde rapor edilen birçok olgudan farklı olarak özefagusunda yenmeyen inorganik madde saptanması ve antemortem semptom tanımlamayan bir otistik olması nedeniyle özellik arz etmektedir. Ayrıca bu rapor ile oral davranış problemleri nedeniyle sıkı gözetim altında bulundurulması gereken otizm hastalarına da dikkat çekilmesi amaçlanmıştır.

Anahtar Kelimeler

• aorta-özefageal fistül
• otizm
• otopsi

DEATH OF AN AUTISTIC ADULT CAUSED BY AORTO-OESOPHAGEAL FİSTULA DUE TO SWALLOWED WIRE: A CASE REPORT

Öz

Although it has a low prevalence, aorto-oesophageal fistula shows a fatal course due to upper gastrointestinal bleeding. Its most common cause of aorto-oesophageal fistula is thoracic aortic aneurysm, followed by foreign body aspiration. Our case is a 43-year old male who suffered from autism and epilepsy, found dead by his family. According to his family, our case had oral behavioral problems such as occasionally putting bugs into his mouth and swallowing them. Although chest pain is the primary symptom in most of the aorto-oesophageal fistula cases, no symptom that attracted the attention of his family was defined in our case because of his communicational problems due to autism. In his autopsy performed in the Morgue Department of Council of Forensic Medicine - Istanbul, a metal wire with a 0,1cm diameter and 9,5cm length that is curled to an arc shape was detected to be penetrated to the back wall of the esophageal lumen and to the neighboring descending aorta proximal. A total of 1500mL of coagulated blood was detected in the esophageal lumen and in the stomach due to developed fistula. Our case is special and different from the most of the cases reported in the literature since an inedible inorganic body was found in his esophagus and since he was an autistic with no definition of ante mortem symptoms. Moreover, it is aimed to attract with this report the attention to the patients suffering from autism who should be kept under a close watch due to oral behavioral problems.

Anahtar Kelimeler

• aorto-oesophageal fistula
• autism
• autopsy

Kaynakça

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