Araştırma Makalesi
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Yaşlılarda Sık Görülen Cerrahi Acil Durum: Akut Mekanik Bağırsak Tıkanıklığı

Yıl 2020, , 156 - 165, 31.08.2020
https://doi.org/10.34084/bshr.777004

Öz

Amaç: Akut mekanik bağırsak tıkanıklığı (AMBT) yaygın bir cerrahi acil durumdur. Geriatrik has-talarda AMBO acil vakaların yaklaşık% 12-15'ini oluşturur ve% 50'si acil operasyon gerektirir. Bu çalışmanın amacı AMBO için ameliyat edilen yaşlıların etiyolojik faktörlerini, tedavi seçeneklerini ve sonuçlarını gözden geçirmektir.
Materyal ve metod: Ocak 2015 - Aralık 2019 tarihleri arasında AMBT nedeniyle ameliyat edilen 65 yaş üstü hastaların dosyaları geriye dönük olarak incelendi. AMBT'nin etyolojik faktörleri yaş, cinsiyet, tıkanıklığın lokalizasyonu, önceki ameliyatlar, cerrahi prosedür, histopatolojik bulgular ve sağkalım açısından gözden geçirilmiştir.
Sonuçlar: AMBT olan 281 hastanın yaş ortalaması 73.4 ± 13,69 saptandı. Hastaların % 53.3'ü (n = 150) erkek,% 46.7'si (n = 131) kadındı. Akut mekanik ince barsak tıkanıklığı (AMİBT) vakaların % 54.09’nu ve akut mekanik kalın barsak tıkanıklığı (AMKBT) olguların % 45.91’u oluşturmaktaydı . Kadınlarda AMBO'nun en yaygın nedeni % 14.9 ile fıtık iken, erkeklerde% 26.6 ile tümöral neden-lerdi. Tüm AMBT olgularında % 39.5 ile tümörler en sık nedendi. Tümöral nedenler % 44.4 ile en sık mortalite nedeni olarak saptandı. Takiben % 22.2 ile herniler ikinci en sık mortalite nedeni olarak bulundu. Toplam ölüm oranı% 9.6 (n = 27) idi. Mortalite saptanan hastaların % 66.6'sında (n = 18) tanı AMİBT’ idi.
Tartışma: Bu çalışmada, literatürle uyumlu olarak yaşlı hasta populasyonunda AMBT’nın en sık görülen nedenleri tümöral nedenler ve fıtıklar olarak saptanmıştır; ancak endemik bölgelerde sık görülen diğer nedenler de - bezoarlar gibi- yaşlı hastalarda AMBT açısından akılda tutulmalıdır.

Destekleyen Kurum

YOK

Kaynakça

  • 1) Hucl T. Acute GI obstruction. Best Pract Res Clin Gastroenterol. 2013 Oct;27(5):691-707. doi: 10.1016/j.bpg.2013.09.001. Epub 2013 Sep 15. Review.
  • 2) Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician 2011;83:159–65.
  • 3) Jackson P, Vigiola Cruz M. Intestinal Obstruction: Evaluation and Management. Am Fam Physician. 2018 Sep 15; 98(6):362-367.)
  • 4) Wangensteen OH. Understanding the bowel obstruction problem. Am J Surg. 1978;135(2):131–149.
  • 5) Ozturk E, van Iersel M, Stommel MM, Schoon Y, Ten Broek RR, van Goor H. Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care. World J Emerg Surg. 2018; 13:48. Epub 2018 Oct 20.
  • 6) van Beekum CJ, Stoffels B, von Websky M, Dohmen J, Paul CJJ, Kalff JC, Vilz TO. Mechanical bowel obstruction in geriatric patients : Etiology and perioperative morbidi-ty/mortality compared with a younger cohort. Med Klin Intensivmed Notfmed. 2020 Feb;115(1):22-28. doi: 10.1007/s00063-019-00637-3. Epub 2019 Dec 2.
  • 7) Krause WR, Webb TP. Geriatric small bowel obstruction: an analysis of treatment and outcomes compared with a younger cohort. Am J Surg. 2015 Feb; 209(2):347-51. Epub 2014 Jun 21
  • 8) Pędziwiatr M, Budzyński P, Stanek M, Matłok M, Major P, Wierdak M, Migaczewski M, Rembiasz K, Budzyński A. Mechanical Bowel Obstruction Changes in Aetiology over the Past 145 Years: A Single Centre Retrospective Cohort Study. Acta Chir Belg. 2015 Nov-Dec;115(6):397-403.
  • 9) Akcakaya A, Sahin M, Coskun A, Demiray S. Comparison of mechanical bowel ob-struction cases of intra-abdominal tumor and non-tumoral origin. World J Surg 2006;30:1295–9.
  • 10) Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Gian-nopoulos P, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 2007;13:432–7.
  • 11) McEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S, et al. Current spectrum of intestinal obstruction. Br J Surg 1987;74:976-980.
  • 12) Soressa U, Mamo A, Hiko D, Fentahun N. Prevalence,causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia. BMC Surg 2016;16:38.
  • 13) Menzies D. Postoperative adhesions: their treatment and relevance in clinical practice. Ann R Coll Surg Engl 1993;75:147–53.
  • 14) ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, Bak-kum EA, Rovers MM, van Goor H. Burden of adhesions in abdominal and pelvic sur-gery: systematic review and met-analysis. BMJ 2013;347:f5588.
  • 15) Hajibandeh S, Hajibandeh S, Panda N, Khan RMA, Bandyopadhyay SK, Dalmia S, Malik S, Huq Z, Mansour M. Operative versus non-operative management of adhe-sive small bowel obstruction: A systematic review and meta-analysis. Int J Surg 2017;45:58–66.
  • 16) Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM, Surgical and Clinical Adhesions Research (SCAR) Group. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis [Internet]. 2005;7(6):551–558.
  • 17) Hackenberg T, Mentula P, Leppäniemi A, Sallinen V. Laparoscopic versus Open Surgery for Acute Adhesive Small Bowel Obstruction: A Propensity Score-Matched Analysis. Scand J Surg. 2017 Mar; 106(1):28-33.
  • 18) Köstenbauer J, Truskett PG. Current management of adhesive small bowel ob-struction. ANZ J Surg. 2018 Nov; 88(11):1117-1122. Epub 2018 May 14.
  • 19) Higashi H, Shida H, Ban K, et al. Factors affecting successful palliative surgery for malignant bowel obstruction due to peritoneal dissemination from colorectal cancer. Jpn J Clin Oncol 2003;33:357–9.
  • 20) Bryan D, Radbod R, Berek J. An analysis of surgical versus chemotherapeutic intervention for the management of intestinal obstruction in advanced ovarian cancer. Int J Gynecol Cancer 2004;16:125–34.
  • 21) Legendre H, Vanhuyse F, Caroli-Bosc FX, Pector JC. Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction. Eur J Surg Oncol 2001;27:364–7.
  • 22) Pisano M, Zorcolo L, Merli C, et all. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 2018;13:36.
  • 23) Karakaş DÖ, Yeşiltaş M, Gökçek B, Eğin S, Hot S. Etiology, management, and survival of acute mechanical bowel obstruction: Five-year results of a training and re-search hospital in Turkey. Ulus Travma Acil Cerrahi Derg. 2019 May;25(3):268-280. doi: 10.14744/tjtes.2019.44834.
  • 24) Hayden GE, Sprouse KL. Bowel obstruction and hernia. Emerg Med Clin North Am 2011;29:319–45, ix.
  • 25) Gök AFK, Sönmez RE, Kantarcı TR, Bayraktar A, Emiroğlu S, İlhan M, Güloğlu R.Discussing treatment strategies for acute mechanical intestinal obstruction caused by phytobezoar: A single-center retrospective study. Ulus Travma Acil Cerrahi Derg. 2019 Aug;25(5):503-509. doi: 10.14744/tjtes.2019.24557.
  • 26) Perrot L, Fohlen A, Alves A, Lubrano J. Management of the colonic volvulus in 2016. J Visc Surg 2016;153:183–92.
  • 27) Berg DF, Bahadursingh AM, Kaminski DL, Longo WE. Acute surgical emergen-cies in inflammatory bowel disease. Am J Surg 2002;184:45–51.
  • 28) Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ, Imagawa DK, Demirjian AN. Surgery for gallstone ileus: a nationwide comparison of trends and out-comes. Ann Surg. 2014 Feb; 259(2):329-35.
  • 29) Jaung R, Kularatna M, Robertson JP, Vather R, Rowbotham D, MacCormick AD, Bissett IP. Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Out-comes. World J Surg. 2017 Sep;41(9):2258-2265. doi: 10.1007/s00268-017-4012-9.
  • 30) Fazel A, Verne GN. New solutions to an old problem: acute colonic pseudo-obstruction. J Clin Gastroenterol 2005;39(1):17—20.)

A Common Surgical Emergency In Elderly: Acute Mechanical Bowel Obstruction

Yıl 2020, , 156 - 165, 31.08.2020
https://doi.org/10.34084/bshr.777004

Öz

Aim: Acute mechanical bowel obstruction (AMBO) is a common surgical emergency. İn geriatric patients, AMBO makes up about 12-15% of emergency cases and 50% of them require urgent oper-ation. The aim of this study is to review the etiological factors, treatment options and the outcome of elderly who had been operated for AMBO.
Material and Methods: The files of patients, over the age of 65 and operated due to AMBO be-tween January 2015 and December 2019, have been retrospectively examined. The etiologic factors of AMBO have been reviewed in terms of age, gender, localization of obstruction, previous surger-ies, surgical procedure, histopathologic findings and survival.
Results: The mean age of 281 patients with AMBO was 73.4±13,69. 53.3% (n=150) of the patients were male, and 46.7% (n=131) were female. AMSBO cases formed 54.09%, and AMLBO 45.91%. The most common reason for AMBO in females was hernias with 14.9% , while that of males was tumors with 26.6%. Tumors were the most common reason in all AMBO cases with 39.5%. Tumor was the most common mortality reason with 44.4% , followed by hernias with 22.2%. Total mortali-ty rate was 9.6% (n=27). In 66.6% (n=18) of the patients in which mortality was detected, the diag-nosis was AMLBO.
Conclusions: The findings of this study supports the current data about etiological factors of AM-BO in elderly with tumors and hernias being the most common; besides the other finding -considering bezoars - that reflect different rates of an endemic area.

Kaynakça

  • 1) Hucl T. Acute GI obstruction. Best Pract Res Clin Gastroenterol. 2013 Oct;27(5):691-707. doi: 10.1016/j.bpg.2013.09.001. Epub 2013 Sep 15. Review.
  • 2) Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician 2011;83:159–65.
  • 3) Jackson P, Vigiola Cruz M. Intestinal Obstruction: Evaluation and Management. Am Fam Physician. 2018 Sep 15; 98(6):362-367.)
  • 4) Wangensteen OH. Understanding the bowel obstruction problem. Am J Surg. 1978;135(2):131–149.
  • 5) Ozturk E, van Iersel M, Stommel MM, Schoon Y, Ten Broek RR, van Goor H. Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care. World J Emerg Surg. 2018; 13:48. Epub 2018 Oct 20.
  • 6) van Beekum CJ, Stoffels B, von Websky M, Dohmen J, Paul CJJ, Kalff JC, Vilz TO. Mechanical bowel obstruction in geriatric patients : Etiology and perioperative morbidi-ty/mortality compared with a younger cohort. Med Klin Intensivmed Notfmed. 2020 Feb;115(1):22-28. doi: 10.1007/s00063-019-00637-3. Epub 2019 Dec 2.
  • 7) Krause WR, Webb TP. Geriatric small bowel obstruction: an analysis of treatment and outcomes compared with a younger cohort. Am J Surg. 2015 Feb; 209(2):347-51. Epub 2014 Jun 21
  • 8) Pędziwiatr M, Budzyński P, Stanek M, Matłok M, Major P, Wierdak M, Migaczewski M, Rembiasz K, Budzyński A. Mechanical Bowel Obstruction Changes in Aetiology over the Past 145 Years: A Single Centre Retrospective Cohort Study. Acta Chir Belg. 2015 Nov-Dec;115(6):397-403.
  • 9) Akcakaya A, Sahin M, Coskun A, Demiray S. Comparison of mechanical bowel ob-struction cases of intra-abdominal tumor and non-tumoral origin. World J Surg 2006;30:1295–9.
  • 10) Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Gian-nopoulos P, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 2007;13:432–7.
  • 11) McEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S, et al. Current spectrum of intestinal obstruction. Br J Surg 1987;74:976-980.
  • 12) Soressa U, Mamo A, Hiko D, Fentahun N. Prevalence,causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia. BMC Surg 2016;16:38.
  • 13) Menzies D. Postoperative adhesions: their treatment and relevance in clinical practice. Ann R Coll Surg Engl 1993;75:147–53.
  • 14) ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, Bak-kum EA, Rovers MM, van Goor H. Burden of adhesions in abdominal and pelvic sur-gery: systematic review and met-analysis. BMJ 2013;347:f5588.
  • 15) Hajibandeh S, Hajibandeh S, Panda N, Khan RMA, Bandyopadhyay SK, Dalmia S, Malik S, Huq Z, Mansour M. Operative versus non-operative management of adhe-sive small bowel obstruction: A systematic review and meta-analysis. Int J Surg 2017;45:58–66.
  • 16) Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM, Surgical and Clinical Adhesions Research (SCAR) Group. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis [Internet]. 2005;7(6):551–558.
  • 17) Hackenberg T, Mentula P, Leppäniemi A, Sallinen V. Laparoscopic versus Open Surgery for Acute Adhesive Small Bowel Obstruction: A Propensity Score-Matched Analysis. Scand J Surg. 2017 Mar; 106(1):28-33.
  • 18) Köstenbauer J, Truskett PG. Current management of adhesive small bowel ob-struction. ANZ J Surg. 2018 Nov; 88(11):1117-1122. Epub 2018 May 14.
  • 19) Higashi H, Shida H, Ban K, et al. Factors affecting successful palliative surgery for malignant bowel obstruction due to peritoneal dissemination from colorectal cancer. Jpn J Clin Oncol 2003;33:357–9.
  • 20) Bryan D, Radbod R, Berek J. An analysis of surgical versus chemotherapeutic intervention for the management of intestinal obstruction in advanced ovarian cancer. Int J Gynecol Cancer 2004;16:125–34.
  • 21) Legendre H, Vanhuyse F, Caroli-Bosc FX, Pector JC. Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction. Eur J Surg Oncol 2001;27:364–7.
  • 22) Pisano M, Zorcolo L, Merli C, et all. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 2018;13:36.
  • 23) Karakaş DÖ, Yeşiltaş M, Gökçek B, Eğin S, Hot S. Etiology, management, and survival of acute mechanical bowel obstruction: Five-year results of a training and re-search hospital in Turkey. Ulus Travma Acil Cerrahi Derg. 2019 May;25(3):268-280. doi: 10.14744/tjtes.2019.44834.
  • 24) Hayden GE, Sprouse KL. Bowel obstruction and hernia. Emerg Med Clin North Am 2011;29:319–45, ix.
  • 25) Gök AFK, Sönmez RE, Kantarcı TR, Bayraktar A, Emiroğlu S, İlhan M, Güloğlu R.Discussing treatment strategies for acute mechanical intestinal obstruction caused by phytobezoar: A single-center retrospective study. Ulus Travma Acil Cerrahi Derg. 2019 Aug;25(5):503-509. doi: 10.14744/tjtes.2019.24557.
  • 26) Perrot L, Fohlen A, Alves A, Lubrano J. Management of the colonic volvulus in 2016. J Visc Surg 2016;153:183–92.
  • 27) Berg DF, Bahadursingh AM, Kaminski DL, Longo WE. Acute surgical emergen-cies in inflammatory bowel disease. Am J Surg 2002;184:45–51.
  • 28) Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ, Imagawa DK, Demirjian AN. Surgery for gallstone ileus: a nationwide comparison of trends and out-comes. Ann Surg. 2014 Feb; 259(2):329-35.
  • 29) Jaung R, Kularatna M, Robertson JP, Vather R, Rowbotham D, MacCormick AD, Bissett IP. Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Out-comes. World J Surg. 2017 Sep;41(9):2258-2265. doi: 10.1007/s00268-017-4012-9.
  • 30) Fazel A, Verne GN. New solutions to an old problem: acute colonic pseudo-obstruction. J Clin Gastroenterol 2005;39(1):17—20.)
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Enis Dikicier 0000-0002-5074-0299

Yesim Akdeniz 0000-0001-7820-7448

Kayhan Özdemir 0000-0002-8041-198X

Muhammed Kamburoğlu Bu kişi benim 0000-0003-2242-5723

Barış Mantoğlu 0000-0002-2161-3629

Emre Gönüllü Bu kişi benim 0000-0001-6391-4414

Yayımlanma Tarihi 31 Ağustos 2020
Kabul Tarihi 20 Ağustos 2020
Yayımlandığı Sayı Yıl 2020

Kaynak Göster

AMA Dikicier E, Akdeniz Y, Özdemir K, Kamburoğlu M, Mantoğlu B, Gönüllü E. A Common Surgical Emergency In Elderly: Acute Mechanical Bowel Obstruction. J Biotechnol and Strategic Health Res. Ağustos 2020;4(2):156-165. doi:10.34084/bshr.777004
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