Histerektomi Sonrası Görülen İleusun Drenle ve Medikal Uygulamalar ile Tedavisi; Bir Olgu Sunumu

Postoperatif ileus (POI), önemli morbidite ve mortalitesi olan karmaşık bir olgu olup, birçok cerrahi alanda görülebilmektedir. Bilinen riski olmayan 50 yaşında bir kadın hastaya tedaviye dirençli menometroraji tanısı ile total abdominal histerektomi ve bilateral salpenjeooferektomi (TAH+BSO) uygulandı. Peroperatif ve postoperatif dönemde herhangi bir problemi olmayan, gaz gaita çıkışı gözlemlenen hasta postoperatif 4. günde taburcu edildi. Ancak postoperatif 6. günde kusma karın ağrısı (akut batın tablosu) ile acil servise başvurduğunda kliniği, tahlilleri ve görüntüleme yöntemleriyle ileus gelişmiş olduğu saptandı. Bunun üzerine, hastada oral alım kapatıldı, medikal tedavi olarak metoklopramid ve laktasif lavman başlandı. Yapılan görüntülenme yöntemlerinde batın içi ve cilt altı ileusa bağlı seröz sıvı izlendi ve hastaya cilt altı hemovac dren konularak batın rahatlatıldı. Yaklaşık 5 gün içinde re-operasyona gerek duyulmadan hastanın ileusu sonlandı ve hasta şifa ile taburcu edildi. Biz bu olgu sunumumuzda basit ama etkili yöntemlerle POI’nin önlenip, erken dönemde operasyona gerek kalmadan, tedavi edilebileceğini göstermiş olduk.

Anahtar Kelimeler:

İleus, dren, metoklopramid

Treatment of Ileus After Hysterectomy with Drain and Medical Applications; A Case Report

Postoperative ileus (POI) is a complex phenomenon with significant morbidity and mortality and can be seen in many surgical fields. A 50-year-old woman with no known risk was diagnosed with treatment-resistant menometrorrhagia and underwent total abdominal hysterectomy and bilateral salpingeooophorectomy (TAH+BSO). The patient, who did not have any problems in the perioperative and postoperative periods, and gas-fecal output was observed, was discharged on the 4th postoperative day. However, on the 6th postoperative day, when he applied to the emergency service with vomiting and abdominal pain (acute abdomen), ileus was found to have developed by his clinic, analyzes and imaging methods. Thereupon, oral intake was stopped in the patient, and metoclopramide and lactase enema were started as medical treatment. In the imaging methods performed, serous fluid related to the intra-abdominal and subcutaneous ileus was observed and the patient was relieved by placing a subcutaneous hemovac drain. In about 5 days, the patient's ileus ended without the need for re-operation and the patient was discharged with full recovery. In this case report, we have shown that POI can be prevented and treated without the need for an operation in the early period with simple but effective methods.

Keywords:

Ileus, drain, metoclopramide,

PDF

___

1. Sheyn D, Bretschneider CE, Mahajan ST, Ridgeway B, Davenport A, Pollard R. Incidence and risk factors of early postoperative small bowel obstruction in patients undergoing hysterectomy for benign indications. Am J Obstet Gynecol. 2019;220(3):251.e1-251.e9.
2. Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, et al. Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg. 2016;153(6):439-46.
3. Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 2013; 17(50:962-72.
4. Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015;34(3):367-76.
5. Carroll J, Alavi K. Pathogenesis and Management of Postoperative Ileus. Clin Colon Rectal Surg. 2009;22(1):47-50.
6. Barbosa RN, Andres MP, Kho RM, Abrao MS. Ileum Endometriosis: A Cause of Bowel Obstruction. J Minim Invas Gyn. 2018;25(5): 759-60.
7. Petca A, Borislavschi A, Dumitrascu MC, Sandru F, Geoarsa M, Petca RC. Postoperative Ileus Complicated with Incomplete Evisceration after Hysterectomy for Benign Pathology. Chirurgia (Bucur). 2020 Jan-Feb;115(1):112-9. doi: 10.21614/chirurgia.115.1.112. PMID: 32155406.
8. Ağbaba N, Ateş Özcan B. Bariatrik cerrahi sonrası gıda intoleransı. Sağlık ve Yaşam Bilimleri Dergisi. 2020;2(1):16-21. https://doi.org/10.33308/2687248X.202021171.
9. Su'a BU, Pollock TT, Lemanu DP, MacCormick AD, Connolly AB, Hill AG. Chewing gum and postoperative ileus in adults: a systematic literature review and meta analysis. Int J Surg. 2015 Feb;14:49-55. doi: 10.1016/j.ijsu.2014.12.032. Epub 2015 Jan 7. PMID: 25576763.
10. Sahin B, Cura Şahin G. The effect on postoperative bowel movement of intraoperative drain application during laparoscopic bilateral tubal sterilization. Pamukkale Tıp Dergisi. 2022;15(3):8-8.