Çölyak Arter Stent Oklüzyonunun Cerrahi Tedavisi; Nadir Bir Olgu Sunumu ‘Aorto-Hepatik Baypas’

Yıl 2023, , 262 - 265, 31.08.2023

Yüksel Dereli , Mehmet Işık , Ömer Tanyeli , Özgür Altınbaş

https://doi.org/10.29058/mjwbs.1160068

Öz

Amaç: Kronik mezenter iskemi; iştahsızlık, kilo kaybı, yemeklerden sonra meydana gelen karın ağrısı
ile seyreden, nadir bir klinik durumdur. İleri yaş ve ateroskleroz en önemli iki risk faktörü olmakla birlikte
multi-sistemik durumlara da eşlik edebilir.Mezenter iskemiye neden olan çölyak, superior ve inferior
mezenter arter stenozunun tedavisinde çeşitli yöntemler mevcuttur. Bu yöntemler; geleneksel cerrahi,
endovasküler yaklaşım ve endarterektomi olarak sayılabilir. Bu çalışmada çölyak arterindeki stenti
tıkanan ve sonrasında aorto-hepatik baypas yapılan hastanın sunulması planlandı.
Olgu: Malign mide tümörü nedeni ile 15 yıl önce opere edilen ve 2 yıl önce de çölyak arter stenozu
tespit edilip stent yerleştirilen 62 yaşındaki erkek hastada karın ağrısı şikayetlerinin tekrarlaması üzerine
yapılan CT anjiografide çölyak arterdeki stentte tıkanıklık tespit edildi.ikinci kez batın açılarak infrarenal
aorta ile hepatik arter arasına safen ven ile baypas operasyonu yapıldı.
Sonuç: Kronik mezenter iskemi, karın ağrısı etiyolojisinde düşünülmesi gereken bir patoloji olup söz
konusu hastalığa neden olabilecek arteriyel tıkanıklıkların tedavisinde endovasküler yönteme uygun
olmayan veya öncesinde endovasküler işlem yapılıp ikincil bir girişim gereken durumlarda açık cerrahi
yöntem uygulanabilir bir metoddur

Anahtar Kelimeler

Kronik mezenter iskemi, Çölyak arter, Stent, Baypas

Surgical Treatment of Stent Occlusion in Celiac Artery; A Rare Case Report ‘Aorto-Hepatic Bypass’

Öz

Objective: Chronic mesenteric ischemia is a rare clinical condition characterized by loss of appetite,
weight loss, and abdominal pain after meals. Although advanced age and atherosclerosis are the two
most important risk factors, they can also accompany multi-systemic conditions. Various methods are
available for the treatment of celiac, superior and inferior mesenteric artery stenosis causing mesenteric
ischemia. These methods are; traditional surgery, endovascular approach and endarterectomy. In this
study, it was planned to present a patient whose stent was occluded in the celiac artery and who
subsequently underwent aorto-hepatic bypass.
Case: A 62 year old male patient who was operated for a malignant gastric tumor 15 years ago and
to whom stent was replaced to the celiac artery due to stenosis 2 years ago, admitted to the clinic for
recurrency of abdominal pain. CT angiography was performed and stent obstruction was detected in
the celiac artery. The abdomen was opened for the second time and a bypass operation was performed
with the saphenous vein between the infrarenal aorta and the hepatic artery.
Conclusion: Chronic mesenteric ischemia is a pathology that should be considered in the etiology of
abdominal pain, and open surgery is a viable method in the treatment of arterial occlusions that may
cause the disease in question, in cases where endovascular method is not suitable or a secondary
intervention is required after endovascular procedure is performed beforehand

Anahtar Kelimeler

Chronic mesenter ischemia, Celiac artery, Stent, Bypass

Kaynakça

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