Therapeutic management of lower gastrointestinal bleeding: Comparison of surgery and minimally invasive treatment modalitiesy

Öz

Background and Aims:Lower gastrointestinal system bleeding is caused by gastrointestinal pathologies from the distal ligament of Treitz. In this study, we aimed to determine the preoperative and postoperative period data of patients who underwent emergency surgery and the follow-up data of those patients who were followed non-operatively because of lower gastrointestinal system bleeding. Materials and Methods: Twenty-nine patients who were followed and operated because of lower gastrointestinal system bleeding and 23 patients who were followed with medical treatment without operation in Ege University Medical Faculty Hospital, Department of General Surgery, were analyzed retrospectively. The parameters included in the examination were as follows: initial complaint, clinical findings, imaging studies, operative findings, morbidity, and mortality. Results:Fiftytwo patients were analyzed retrospectively with the diagnosis of lower gastrointestinal system bleeding between April 2008 and April 2012. The mean age was determined as 62,4 years in the operated group. In this group, 12 (41,3%) patients were female and 17 (58,7%) were male. In the non-operative follow-up group, the mean age was 64,9, and 7 (30,4%) were female and 16 (69,6%) were males. The mortality rate was determined as 10,3% (3 patients) in the operated group and 8,7% (2 patients) in the non-operative follow-up group. Conclusions: Colonoscopic hemostasis techniques were used safely and widely for the treatment of lower gastrointestinal system bleeding. The mortality rate is about 10-15% as a result of massive bleeding; the bleeding site must be identified and treated as quickly as possible. 80%-90% of lower gastrointestinal system bleeding stop spontaneously or with conservative measures. If bleeding cannot be controlled by colonoscopic or angiographic methods, surgical intervention is indicated, and the decision to operate should not be delayed.

Anahtar Kelimeler

• Lower gastrointestinal system, bleeding, surgery

Alt gastrointestinal sistem kanamalarında tedavi yönetimi: Cerrahi ve minimal invaziv tedavi yöntemlerinin irdelenmesi

Öz

Giriş ve Amaç:Alt gastrointestinal sistem kanamaları, Treitz ligamanı-nın distalindeki gastrointestinal sisteme ait patolojilerden kaynaklanır. Bu çalışmada kliniğimizde, akut alt gastrointestinal sistem kanaması nedeniyle acil cerrahi uygulanan ve non-operatif takip edilen hastaların preoperatif ve postoperatif dönemdeki verilerinin ve izlem verilerinin irdelenmesi amaçlandı. Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Hastanesi Genel Cerrahi Anabilim Dalında alt gastrointestinal sistem kanaması nedeni ile takip ve operasyon uygulanan 29 hasta ve opere edilmeden medikal izlem ile takip edilen 23 hasta retrospektif olarak incelendi. İncelemeye dahil edilen parametreler; başvuru şikayeti, muayene bulguları, görüntüleme yöntemleri, operasyon bulguları, morbidite, mortalite olarak belirlendi. Bulgular: Nisan 2008–Nisan 2012 tarihleri arasında alt gastrointestinal sistem kanaması tanısı alan 52 hasta retrospektif olarak incelendi. Acil cerrahi uygulanan grupta ortalama yaş 62,4 olarak belirlendi. Bu grupta; 12 (%41,3) hasta kadın, 17 (%58,7) hasta ise erkek idi. Non-operatif takip grubunda ise ortalama yaş 64,9, 7 (%30,4) kadın, 16 (%69,6) hasta ise erkek idi. Mortalite oranı opere edilen grupta %10,3 (3 hasta), non-operatif takip grubunda ise %8,7 (2 hasta) olarak belirlendi. Sonuç:Akut alt gastrointestinal sistem kanamalarının tedavisinde kolonoskopik hemostaz teknikleri güvenli ve yaygın bir şekilde kullanılabilmektedir. Masif kanama sonucu mortalite oranı yaklaşık %10-15 olduğundan, olabildiğince hızlı bir şekilde kanama odağı tespit edilerek müdahale edilmelidir. Alt gastrointestinal sistem kanamalarının %80-90'ı spontan olarak ya da konservatif önlemlerle durmaktadır. Kolonoskopik veya anjiografik yöntemlerle kontrol altına alınamayan kanamalarda cerrahi girişim endikasyonu vardır ve operasyon kararı geciktirilmemelidir.

Anahtar Kelimeler

• Alt gastrointestinal sistem, kanama, cerrahi

Kaynakça

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