60 YAŞ ÜSTÜ APENDEKTOMİ YAPILAN OLGULARIN RETROSPEKTİF ANALİZİ

Öz

Akut apandisit en sık gözlenen acil cerrahi hastalıktır. Daha çok gençlerde görülür. Çalışmamızda apendektomi yapılan 60 yaş üstü hastaları sunduk. Akut apandisit öntanısı ile Kasım 2011-Mart 2013 tarihleri arasında apendektomi yapılan 60 yaş üstü hastaların dosya ve bilgisayar kayıtları retrospektif olarak değerlendirildi.Ameliyat öncesi Alvarado skorları, US ve BT bulguları, morbidite, mortalite ve histopatoloji sonuçları incelendi. Toplam 172 hastaya akut apandisit öntanısı ile apendektomi yapıldı. Bu hastaların 60 yaş ve üzeri olan 13 %7.5 'ü çalışmaya dahil edildi. Hastaların 9 %59.3 'u erkek, 4 %30.7 'ü kadın idi. Yaş ortalaması 67.1 idi. Alvarado skoru 8 %61.5 hastada 7 ve üzerinde, 5 %38.5 hastada 4-7 arasında idi.Ameliyat öncesi 11 hastaya US, 7 hastaya BT yapıldı.Ameliyat sonrasında 1 %7.7 hastada akut böbrek yetmezliği, 1 %7.7 hastada yüzeyel yara yeri enfeksiyonu gözlendi. Mortalite görülmedi. Histopatolojik incelemede 6 %46.1 hasta akut apandisit, 2 %15.3 hasta perfore apandisit, 2 %15.3 hasta flegmonöz apandisit, 1 %7.7 hasta divertikülit perforasyonu, 2 %15.3 hasta ise normal appendiks bulguları olarak değerlendirildi. Negatif laparotomi oranı %15.3 idi. US, pozitif laparotomi yapılan tüm hastalara yapılmıştı. Bunlardan 4 %36.3 ’ünde ultrasonografi bulguları akut apandisit ile uyumlu, kalan7 %63.7 ’sinde uyumlu değildi. BT ise, pozitif laparotomi yapılan hastalardan yedisine yapılmıştı. Bunlardan 5 %71.4 'inde BT bulguları akut apandisit ile uyumlu, 2’sinde %28.6 uyumlu değildi. Negatif laparotomi yapılan 2 hastadan birinin hem USG hemde BT bulguları normal, diğerinde ise akut apandisit ile uyumlu idi. Akut apandisit daha çok genç yaş grubunda görülür. 60 yaş üzerinde daha nadir görülmesi, tanı koymadaki güçlük ve ameliyat sonrasındaki komplikasyonların daha fazla görülmesi nedeniyle tanı koyma sürecinde daha dikkatli olunmalıdır

Anahtar Kelimeler

• Akut Apandisit,ileri yaş,akut karın,morbidite,mortalite

THE RETROSPECTIVE ANALYSIS OF CASES OVER 60 YEARS OLD WHO PERFORMED APPENDECTOMY

Abstract

Acute appendicitis is the most common emergency surgical disease. It is commonly seen in young patients. In this study we present cases who were performed appendectomy over 60 years old. We reviewed retrospectively the patients who were performed appendectomy with the diagnosis of acute appendicitis over 60 years old with files and computer records between November 2011-March 2013 in Izmir Bozyaka Education and Research Hospital, Surgery Clinic. Alvarado score, USG and CT findings, morbidity, mortality, and histopathology reports were analyzed Appendectomy was performed with the diagnosis of acute appendicitis in total of 172 patients. 13 7.5% of these patients who was 60 years of age and above were included in the study. 9 59.3% patients were male and 4 30.7% of them were female. The mean age was 67.1 years. Alvarado score was in 8 61,5% patients 7 and above and in 5 38,5% was between 4-7. In preoperative period US was performed to 11 patients and CT was performed to 7 patients. There was acute renal failure in 1 7,7% patient and there was superficial wound infection in 1 7,7% patient postoperatively. There was no mortality. In histopathological examination there were acute appendicitis in 6 46,1% patients, perforated appendicitis in 2 15,3% patients, phlegmoneus appendicitis in 2 15,3% patients, diverticulitis perforation in 1 7,7% patient, normal appendix findings in 2 15,3% patients. The negative laparotomy rate was 15.3%. US was made to all patients who were performed pozitive laparotomy. In 4 patients 36,3% US findings was compatible with acute appendicitis and in 7 patients 63,7% US findings wasn't compatible with acute appendicitis. CT was performed to 7 patients who were performed positive laparotomy. In 5 71,4% patients CT findings was compatible with acute appendicitis and in 2 28,6% patients CT findings wasn't compatible with acute appendicitis. In 1 of 2 patient who were performed negative laparotomy USG and CT findings were normal and in the other patient USG and CT findings was compatible with acute appendicitis. Conclusion: Acute appendicitis is commanly seen in young patients. Because of they seen rarely over 60 years old, difficulty in diagnosis and postoperative complications are more frequent we should be more careful in the process of diagnosis

Keywords

• Acute appendicitis,elderly,acute abdominal pain,morbidity,mortality

Kaynakça

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