Somali’de Pilor Stenozunun Cerrahi Tedavisi

Yıl 2022, , 382 - 387, 31.08.2022

Adem Küçük , Shukri Said Mohamed , Abdishakur Mohamed Abdi , Abdullahi Yusuf , Mesut Kayse

https://doi.org/10.24938/kutfd.1118531

Öz

Amaç: İnfantil hipertrofik pilor stenozu, bebeklerde yaşamın ilk ayında mide çıkışı obstrüksiyonunun en sık nedenidir. Bu çalışmada, Somali, Mogadişu'da infantil hipertrofik pilor stenozu olan hastaların tanı, hastaneye yatış ve ameliyat prosedürlerini detaylandırmayı amaçladık.

Gereç ve Yöntemler: Bu araştırmada, Mogadişu’da bulunan Recep Tayyip Erdoğan Eğitim ve Araştırma Hastanesi’nde Mayıs 2019-Temmuz 2021 tarihleri arasında infantil hipertrofik pilor stenozu tanısı ile opere edilen 52 hasta retrospektif olarak değerlendirildi. Tüm hastalara abdominal ultrasonografi yapıldı. Kan gazı parametreleri hasta dosyalarından alındı. Ramstedt piloromiyotomi cerrahi tedavisi 52 çocuğa uygulandı.

Bulgular: Çalışma kapsamında değerlendirmeye 18’i (%34.6) kız, 34’ü (%65.4) erkek toplam 52 hasta dahil edildi. Hastaların ortanca yaşı 45 gün (min: 15 gün, maks: 150 gün), ortanca taburculuk günü 6 gündü (min: 3 gün, maks: 9 gün). Sekiz (%15.3) hastada yara enfeksiyonu ve sekiz (%15.3) hastada ameliyat sonrası tekrarlayan kusma görüldü. Kusma şikâyeti olan iki hasta ikinci kez ameliyat edilirken, altı hastada kusma şikayetlerinin postoperatif üçüncü günde düzeldiği gözlendi. Postoperatif dönemde hastalarımızın 4’ü (%7.69) yenidoğan yoğun bakım ünitesinde takip edildi. Ameliyat edilen vakalarda ölüm görülmedi.

Sonuç: Safrasız kusmalı infantil hipertrofik pilor stenozu, Somali'deki bebeklerde sık görülen bir durumdur ve tekrarlayan safrasız kusması olan hastalarda dışlanmalıdır. Hastalar hastaneye geç dönemde getirilmiş olsa da ameliyat koşullarının ve ameliyat sonrası bakım standartlarının ortalamanın altında olduğu bu çalışmada mortalite vakasına rastlanmamıştır.

Anahtar Kelimeler

Somali, safralı olmayan kusma, İnfantil hipertrofik pilorik stenoz, piloromyotomi

Teşekkür

Somali'de sağlık bakanlığı adına görev yaptığım süre içerisinde Üniversitedeki Çocuk Cerrahi asistanları ile ortak yaptığımız retrospektif bir çalışma. Yazımızı değerlendirmeye aldığınız için teşekkürler.

SURGICAL TREATMENT OF PYLORSTENOSIS– FOREIGN EXPERIENCE IN SOMALIA

Öz

Objective: Infantile hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in infants within the first month of life. In this study, we aimed to elaborate the diagnosis, hospitalization and surgery procedures of patients with IHPS in Mogadishu, Somalia.

Material and Methods: In this research, 52 patients who were diagnosed with infantile hypertrophic pyloric stenosis and operated at the Recep Tayyip Erdoğan Training and Research Hospital in Mogadishu, Somalia between May 2019 and July 2021 were evaluated retrospectively. Abdominal ultrasonography was performed to all patients. Blood gas parameters were taken from the patient files. Ramstedt piloromyotomy surgical treatment was applied to 52 children.

Results: A total of 52 patients, 18 (34.6%) female and 34 (65.4%) male, were included in the evaluation within the scope of the study. The median age of the patients was 45 days (min: 15 days, max: 150 days), and the median day of discharge was 6 days (min: 3 days, max: 9 days). Wound infection occurred in eight (15.3%) patients, and postoperative recurrent vomiting occured in eight (15.3%) patients. While two patients with vomiting were operated for the second time, it was observed that the complaints of vomiting in six patients improved on the third postoperative day. Postoperatively, 4 (7.69%) of our patients were followed up in the neonatal intensive care unit. There was no death in the cases we operated on.

Conclusion: Infantile hypertrophic pyloric stenosis with non-bilious vomiting is a common condition in infants in Somalia and must be excluded in patients with recurrent non-bilious vomiting. Although the patients were admitted lately, no case of mortality has been observed in this study cohort where surgery conditions and postoperative care standards were below average.  

Anahtar Kelimeler

Somalia, pyloromyotomy, non-bilious vomiting, infantile hypertrophic pyloric stenosis

Kaynakça

• 1. Puri P, Lakshmanadass G. Hypertrophicpyloric. In: Puri P, ed. Newborn Surgery. Oxford, England. Butter-Worth-Heinemann, 1996:266-71.
• 2. Applegate MS, Druschel CM. The epidemiology of infantile hypertrophicpyloric stenosis in New York state, 1983 to 1990. Arch Pediatr Adolesc Med. 1995;149(10):1123-9.
• 3. To T, Wajja A, Wales PW, Langer JC. Population demographic indicators associated with incidence of pyloric stenosis. Arch Pediatr Adolesc Med. 2005;159(6):520-5.
• 4. Mullassery D, Perry D, Goyal A, Jesudason EC, Losty PD. Surgical practice for infantile hypertrophic pyloric stenosis in the United Kingdom and Ireland—a survey of members of the British Association of Paediatric Surgeons. J Pediatr Surg. 2008;43(6):1227-9.
• 5. Burge DM, Griffiths DM, Steinbrecher HA, Wheeler RA, eds. Paediatric Surgery. 2nd ed. London. Hodder Arnold, 2006:1027-8.
• 6. Tadesse A, Gadisa A. Infantile hypertrophic pyloric stenosis: A retrospective study from a tertiary hospital in Ethiopia. East CentAfr J Surg. 2014;19(1):120-4.
• 7. Saula PW, Hadley GP. Hypertrophic pyloric stenosis in the third world. Trop Doct. 2011;41(4):204-10.
• 8. De Laffolie J, Turial S, Heckmann M, Zimmer K, Schier F. Decline in infantile hypertrophic pyloric stenosis in Germany in 2000-2008. Pediatrics 2012;129:e901-6.
• 9. Touloukian RJ, Higgins E. The spectrum of serum electrolytes in hypertrophic pyloric stenosis. J Pediatr Surg. 1983;18(4):394-7.
• 10. Nmadu PT. Alterations in serum electrolytes in congenital hypertrophic pyloric stenosis: a study in Nigerian children. Ann Trop Paediatr. 1992,12(2):169-172.
• 11. Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis. Radiology. 2003;227(2):319-31.
• 12. Ohri SK, Sackier JM, Singh P. Modified Ramstedt’s pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis. J R Coll Surg Edinb. 1991;36(2):94-6.
• 13. Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007;16(1):27-33.
• 14. Nasr A, Ein SH. Postoperative pyloric stenosis in the newborn: a forgotten problem. J Pediatr Surg. 2007;42(8):1409-11.
• 15. Oetzmann von Sochaczewski C, Muensterer OJ. The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data. Pediatr Surg Int. 2021;37(5):579-85.
• 16. Taylor ND, Cass DT, Holland AJ. Infantile hypertrophic pyloric stenosis: has anything changed? J Paediatr Child Health. 2013;49(1):33-7.
• 17. Taqi E, Boutros J, Emil S, Dubé S, Puligandla P, Flageole H, Laberge JM. Evaluation of surgical approaches to pyloromyotomy: a single-center experience. J Pediatr Surg. 2007;42(5):865-8.
• 18. Chalya PL, Manyama M, Kayange NM, Mabula JB, Massenga A. Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period. BMC Res Notes. 2015;8:690.
• 19. Jlidi S, Youssef DB, Ghorbel S, Mattoussi N, Khemakhem R, Nouira F et al. Infantile hypertrophic pyloric stenosis. Report of 142 cases. Tunis Med. 2008;86(1):63-7.
• 20. Kawahara H, Imura K, Nishikawa M, Yagi M, Kubota A. Intravenous atropine treatment in infantile hypertrophic pyloric stenosis. Arch Dis Child. 2002;87(1):71-74.
• 21. Walker K, Badawi N, Holland AJ, Halliday R. Developmental outcomes following major surgery: what does the literature say? J Paediatr Child Health. 2011;47(11):766-70.
• 22. Williams R, Black I, Sartorelli K. Re: Early developmental outcome of infants with infantile hypertrophic stenosis. J. Pediatr. Surg. 2011;46(6):1298-9.