Mehmet BÜLBÜL, Mustafa GÖKSU, Tuğba MANDAL, Berna DİLBAZ

Sezaryen sonrası nadir bir postoperatif komplikasyon: Tüberküloz Peritonit; Olgu Sunumu

Giriş: Acil alınan vakalarda daha sık görülse de sezaryen doğumlarda (SD) intraabdominal apse nadir komplikasyonlardandır. Postoperatif karın ağrısı, ateş, halsizlik, kabızlık/ishal, insizyon hattında kızarıklık, pürülan akıntı ve insizyon hattında açılma gibi belirtileri olabilir. Günümüzde pulmoner tüberküloz sıklığı artmaktadır. Bununla birlikte tüberküloz peritonit (TP) gibi ekstrapulmoner tüberküloz nadir görülmektedir. Tam olarak hangi mekanizma ile geliştiği bilinmeyen TP’in, nonspesifik semptomlar nedeniyle tanısı zordur. Tanıda öncelikle hastalığın düşünülmesi önemlidir.Vaka: Beş gün önce Sezaryen Doğum (SD) yapan, sonrasında karın ağrısı, halsizlik şikayetiyle başvuran hastaya postoperatif intraabdominal apse tanısıyla relaparatomi yapıldı. Cerrahi tedaviyi sonrasında uygun antibiyotik tedavisi ile semptomları gerileyen ve kontrol görüntüleme yöntemlerinde intraabdominal patoloji saptanmayan hastada tam klinik iyileşme sağlanamadı. Takibinde pulmoner semptomlarının artması üzerine bronkoskopi yapılan hastaya alınan bronş yıkama sıvısında aside dirençli basillerin görülmesiyle pulmuoner tüberküloz tanısı konuldu. Anti tüberküloz tedavi ile tam klinik iyileşme sağlanan hasta TP olarak kabul edildi. Sonuç: Sıklığı artan TP semptomlarının birçok hastalığı taklit etmesi nedeniyle tanısında zorluklar ve gecikmeler olmaktadır. Özellikle risk faktörü olan bireylerde TP akılda tutulmalı ve nadir de olsa postoperatif dönemde akut batına yol açabileceği düşünülmelidir. Erken teşhis morbidite ve mortaliteyi azaltırken gereksiz cerrahi müdahaleyi engeller.

Anahtar Kelimeler:

Sezaryen doğum, İntraabdominal apse, tüberküloz peritonit

İntroduction: Intraabdominal abscess formation is one of the rare complications observed after cesarean deliveries although it might be observed more commonly during emergency c-sections. The most common signs are postoperative abdominal pain, fever, fatigue, constipation or diarrhea, erythema at the site of the incision, purulent discharge and dehiscence of the incision. Recently, there is an increase in the incidence of tuberculosis. Like this, the incidence of rare forms of extrapulmonary tuberculosis cases like tuberculosis peritonitis are also showing an increase. The mechanism of development of peritoneal tuberculosis is still unclear and its diagnosis is difficult due to nonspecific symptoms. Case: The patient who applied with abdominal pain, fatigue five days after cesarean section had a re-laparotomy with the diagnosis of postoperative intraabdominal abscess formation. The clinical recovery after the second operation was slow although the symptoms regressed with the antibiotic regimen applied postoperatively and no intraabdominal pathology was detected postoperatively with the imaging techniques. The patient was diagnosed to have pulmonary tuberculosis with the detection of acid-resistant bacteria in the bronchoalveolar lavage fluid during the bronchoscopy performed due to the aggravated pulmonary symptoms of the patient during the follow-up period. The patient who had full recovery with the antituberculotic medications had no significant medical history. Result: The diagnosis and treatment of peritoneal tuberculosis is delayed due to its symptoms that mimic other pathologies. This entity must be considered especially in high risk patients and the possibility of development of a postoperative abscess due to it must be kept in mind. Early diagnosis will reduce the morbidity and mortality and prevent unnecessary surgical interventions.

Keywords:

Cesarean section, intra-abdominal abscesses, peritonitis tuberculosis,

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