Sigmoid Kolon Torsiyonu: On Dokuz Olgunun Retrospektif Analizi

Yıl 2017, Cilt: 14 Sayı: 2, 117 - 123, 31.08.2017

Metin Yücel Hakan Çakıt Adnan Özpek Fatih Başak Sema Yüksekdağ Aylin Acar Ali Kılıç

Öz

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.

Anahtar Kelimeler

Torsiyon, volvulus, endoskopik detorsiyon

Sigmoid Colon Torsion: Retrospective Analysis of Nineteen Cases

Öz

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: 

Anahtar Kelimeler

Torsion, volvulus, endoscopic detorsion

Kaynakça

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