Surgical outcomes of small bowel obstruction caused by rare etiologies

Yıl 2017, Cilt: 9 Sayı: 4, 155 - 162, 01.12.2017

Tugan Tezcaner , Birkan Birben Yahya Ekici Feza Y Karakayalı Aydıncan Akdur Merih Tepelioğlu Gökhan Moray

https://doi.org/10.21601/ortadogutipdergisi.350364

Öz

Aim: The aim of this study was
evaluaterare causes of small bowel obstruction and outcomes of surgical
treatment.

Material and Method: We have
reviewed medical reports of patients admitted for ileus to our institution
between January 2001 and September 2015 in this cross-sectional retrospective
study. Demographic features, etiology of small bowel obstruction,
predisposition to this etiology, diagnostic studies, surgical procedures and
outcomes of surgery were evaluated.

Results: There were 481 patients were
underwent surgery for mechanical small bowel obstruction during the study
period. Of these patients, 13 (2.8%) patients have small bowel obstruction
caused by rare etiologies. Small bowel obstruction secondary to bezoar (1.0%)
was the most common rare etiology. The others were gallstone ileus (0.6%), Non
Hodgin B cell lymphoma (0.4%), foreign body (0.2%), gastrointestinal stromal
tumor (0.2%) and endometriosis (0.2%). Milking of bezoar, enterolithotomy,
enterotomy, segmentary small bowel resection an ileoceacal resection were
performed according to the etiology. The only postoperative complication was
superficial wound infection in one patient (7.7%). İncisional hernia occurred
in three patients (23.0%) during follow up period. There was no recurrence and
reoperation because of small bowel obstruction.

Conclusion: Diagnosis
of miscellaneous etiologies preoperatively is challenging. Patients with small
bowel obstruction without risk of adhesions may require a low threshold for
early operative intervention keeping in mind these miscellaneous etiologies. 

Anahtar Kelimeler

Bezoar, foreign body, gallstone, gastrointestinal stromal tumor, , intestinal obstruction

İnce barsak obstrüksiyonuna yol açan nadir nedenler ve cerrahi tedavi sonuçları

Öz

Amaç: Bu çalışmada, ince barsak
obstrüksiyonlarının etiyoloji ve cerrahi sonuçları açısından incelenmesi
amaçlandı.

Gereç ve Yöntem: Merkezimizde Ocak 2001 ile
Eylül 2015 tarihleri arasında ileus nedeniyle başvuran hastalar retrospektif
kesitsel olarak incelendi. Nadir mekanik ince barsak obstrüksiyonu olan
hastalar dahil edildi. Hastalar; demografik özellikleri, etiyoloji, etiyolojiye
yatkınlık oluşturan durumlar, tanı çalışmaları, tanı çalışmalarının başarısı,
tedavi yöntemleri ve sonuçları açısından incelendi.

Bulgular: Belirtilen tarihler arasında 481
hasta mekanik ince barsak obstrüksiyonu nedeniyle ameliyat edildi. Hastaların
13’ünde (%2,8) diğer nedenlere bağlı obstrüksiyon saptandı. Bu hastaların
5’inde bezoar (%1,0), 2’sinde B hücreli lenfoma (%0,4), 1’inde yabancı cisim
(%0,2); 3’ünde safra taşı (%0,6), 1’inde gastrointestinal stromal tümör (%0,2)
ve bir hastada endometriyozise (%0,2) bağlı ince barsak obstrüksiyon mevcuttu.
Cerrahi tedavide ezerek ve sağılarak bezoarın ilerletilmesi, enterotomi,
enterolitotomi, segmenter ince barsak rezeksiyonu ve ileoçekal rezeksiyon
uygulandı. Ameliyat sonrası tek komplikasyon, bir hastada (%7,69) görülen
yüzeyel yara yeri enfeksiyonu idi. İzlem süresinde, 3 hastada (%23,0)
insizyonel herni görüldü. Hastaların hiçbirinde ince barsak tıkanıklığı
nedeniyle yeniden ameliyat gerekliliği olmadı.

Sonuç: İnce barsak obstrüksiyonuna yol açan nadir
nedenlerin ameliyat öncesi tanı konulması zordur. Adezyon riski olmayan ince
barsak obstrüksiyonlu hastalarda bu nadir etiyolojiler de göz önünde tutularak
erken dönemde cerrahi tedavi düşünülmelidir. 

Anahtar Kelimeler

Bezoar, gastrointestinal stromal tümör, safra taşı, tıkanıklık, yabancı cisim

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