Bağırsak Obstrüksiyonu Nedeni ile Ameliyat Ettiğimiz Hastaların Değerlendirilmesi

Öz

Bu retrospektif çalışmada mekanik bağırsak obstrüksiyonuna neden durumları irdelemek ve mekanik ince bağırsak obstrüksiyonlarını incelemek istedik. Şubat 2004 ve nisan 2009 tarihleri arasında Ankara Atatürk Eğitim ve Araştırma Hastanesi 2. Cerrahi kliniğinde mekanik bağırsak obstrüksiyonu nedeni ile ameliyat edilen tüm hastaları bu retrospektif çalışmamıza dahil ettik. Mekanik bağırsak obstrüksiyonu nedenlerini irdeledik.21 kadın, 32 erkek 53 hasta mekanik bağırsak obstrüksiyonu nedeniyle ameliyat edildi. Hastaların yaşı 23-89 yaş aralığında, yaş ortalaması ise 62.35 idi. 22 (%41.50) hastada mekanik bağırsak obstrüksiyonu nedeni kalın bağırsak kaynaklı idi. 19 hastada (%86.3) obstrüksiyon sebebi kolon kanseri idi. 1 (%4.5) hastada sigmoid volvulus, 1 hastada (%4.5) divertikülit, 1 (%4.5) hastada da akut kolonik psödoobstrüksiyona bağlı ileus geliştiği tespit edildi.31 (%58.5) hastada mekanik obstrüksiyon nedeni ince bağırsak kaynaklı idi. 15 (% 48.4) hastada geçirilmiş ameliyatlar sonucu gelişmiş yapışıklıklar, 4 (% 12.9) hastada internal fıtıklaşma, 4 (%12.9) kısmi ince bağırsak iskemisi, 4 (%12.9) hastada inkarsere fıtık, 1 (% 3,2) hastada spontan ince bağırsak perforasyonu, 1 (%3.2) hastada ince bağırsak mezenterinde hematom, 1 (%3.2) hastada Meckel divertiküliti, 1 (%3.2) hastada ince bağırsak tümörü saptandı.Mekanik bağırsak obstrüksiyonu nedeniyle ameliyat ettiğimiz hastaların yarıdan fazlasında neden ince bağırsak kaynaklı idi. Geçirilmiş ameliyatı olan hastalarda neden genellikle yapışıklıklar olup konservatif tedavi başansız olursa laparotomi ve adezyolizis planlanmalıdır. Ancak geçirilmiş ameliyatı olmayan hastalarda, nadir görülen, bulguları silik olan internal fıtıklaşma ve kısmi ince bağırsak iskemisi gibi nedenler akla getirilmeli, ileri görüntüleme yöntemlerine başvurulmalı ve ameliyat kararı ivedilikle verilmelidir. Dr. Gülten KIYAK, Dr. Mehmet Yiğit ÖZGÜN, Dr. İbrahim Çağatay ŞİŞMAN, Dr. Birol KORUKLUOĞLU, Dr. Ahmet KUŞDEMİR

Anahtar Kelimeler

• ağırsak obstrüksiyonu
• adezyon
• ayırıcı tanı

Evaluation of Patients Operated Due to Intestinal Obstruction

Öz

ABSTRACT We wished to investigate small bowel obstruction and to determine causes of mechanical obstruction in this retrospective study. All patients undergoing operative treatment at the second surgery department of Atatürk Research and Trainig Hospital for mechanical bowel obstruction between February, 2004 and April, 2009 were included in this study. We explicated the causes of mechanical intestinal obstruction. 21 female, 32 male 53 patients were operated for bowel obstruction. The mean age of this patients was 62.35 (range 23-89). 22 (41.50%) patients had large bowel obstruction as cause of mechanical obstruction. 19 (86.3%) patients had colon carsinoma. It was determined sigmoid volvulus in one (4.5%) patient, diverticülitis in one patient (4.5%) and acute colonic pseudoobstruction in one (4.5%) patient.31 (% 58,5) patients had small bowel obstruction as cause of mechanical obstruction. It was determined abdominal adhesions related with previous operations in 15 (48.4%) patients, internal hreniation in 4 (12.9%) patients, partial small bowel ischemia in 4 (12.9%) patients, incarcerated hernia in 4 (12.9%) patients, spontaneously small bowel perforation in 1 (3.2%) patient, small bowel mesenteric hematoma in 1 (3.2%) patient, Meckel’s diverticülitis in 1 (3.2%) patient, small bowel carcinoma in 1 (3.2%) patient.More than half of patients had small bowel obstruction as cause of mechanical obstruction. Patients operated previously had mostly abdominal adhesions as cause of mechanical obstruction which required la-paratomy and adhesiolysis if conservative treatment failed. But, for patients having not operation previously, it should be considered rare causes of ileus such as internal herniation and partial small bowel ischemia and reuired advanced imaging technique. The clinical situation should require to give a decision for operation.

Anahtar Kelimeler

• Bowel obstruction
• adhesion
• differential diagnosis

Kaynakça

1. 1. Ohmiya N, Arakawa D, Nakamura M, Honda W, Shira 0, Taguchi A, et al. Small-bowel obstruction: diagnostic comparison between double-balloon endoscopy and fluoroscopic enteroclysis, and the outcome of enteroscopic treatment, Gastrointestinal Endoscopy; 2009; 69(1):84-93.
2. 2. Foster NM, Me Gory ML, Zingmond DS, Ko CY. Small bowel obstruction: A populationbased appraisal. J Am Coll Surg 2006; 203(2):170-6.
3. 3. Tanaka S, Yamamoto T, Kubota D, Matsuyama M, Uenishi T, Kubo S, Ono K. Predictive factors for surgical indication in adhesive small bowel obstruction. Am J Surg 2008; 196:23-7.
4. 4. Grafen FC, Neuhaus V, Schöb O, Turina M. Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg DOI; 10.1007/S00423-009-0490-Z.
5. 5. De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg 2009;96:229-39.
6. 6. Kreis ME, Jauch KW. Ileus aus chirurgischer Sicht. Chirurg 2006; 77:883-8.
7. 7. Lo OSH, Law WL, Choi HK, Lee YM, Ho JWC, Seto CL. Early outcomes of surgery for small bowel obstruction: analysis of risk factors. Langenbecks Arch Surg 2007;392:173-8.
8. 8. Ertekin C, Güloğlu R, Taviloğlu K. Acil Cerahi. 1. Baskı. Istanbul: 2009: 327-40.

9. 9. Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ. Laparascopic lysis of adhesions. World J Surg 2006; 30: 535-40.
10. 10. Williams SB, Greenspon J, Young HA, Orkin BA. Small bowel obstruction: conservative vs. surgical management. Dis Col Rec 2005; 48(6):1140-6.
11. 11. Izbicki JR, Schneider CG, Kasti S. Partielle Is-châmien. Chirurg 2003;74:413-8.
12. 12. Okayasu K, Tamamoto F, Nakanishi A, Takanashi T, Maehara T. A case of incarcerated lesser sac hernia protruding simultaneously through both the gastrocolic and gastrohepatic omenta. Radiation Medicine 2002; 20(2): 105-7.
13. 13. Miller G, Boman J, Shrier I, Gordon PH. Etiology of small bowel obstruction. Am J Surg 2000;180(1):33-6.
14. 14. Fraser SA, Shrier I, Miller G, Gordon PH. Immediate postlaparatomy small bowel obstruction: a 16-year retrospective analysis. Am Surg 2002;68(9):780-2.
15. 15. Greene WW. Bowel obstruction in the aged patient. A review of 300 cases. Am J Surg 1985;118:541-5.
16. 16. Schroder J, Kahlke V, Staubach KH, Zabel P, Stuber F. Gender differences in human sepsis. Arch Surg 1998;133:1200-5.
17. 17. Chou CK, Mak CW, Tzeng WS, Chang JM. CT of small bowel ischemia. Abdom Imaging 2004; 29:18-22.