M.Gunay GÜRLEYIK, Oğuzhan SUNAMAK, Zehra ÜNAL ÖZDEMİR, Hakan ÖZDEMİR

KESKİN KENARLI ÖZEFAGUS YABANCI CİSİMLERİNDE RİJİD ENDOSKOPİNİN ÖNEMİ

Özefagus perforasyonları, yüksek mortaliteye sahip acil vakalardır. İyatrojenik, spontan veya yabancı cisme bağlı olabilir. Yabancı cisim varlığında, ilk teşhis yöntemi radyolojik görüntüleme ve enönemli müdahale yöntemi, endoskopidir. Fleksibl endoskopi, kullanım kolaylığı, yaygın kullanımıve düşük komplikasyon riski nedeniyle ilk seçilecek yöntemdir. Rijid endoskopi, deneyim ve genelanestezi gerektirmesi nedeniyle nadiren kullanılır.54 yaşında kadın hasta yemek borusuna kaz kemiği parçası takılması şikayetiyle başvurdu. Direkgrafide servikal özefagusda yabancı cisim görüldü. Fleksibl endoskopi ile cisim çıkarılamadı vekontrol BTsinde komşu dokularda serbest hava ve servikal özefagusda perforasyon görüldü. Genelanestezi altında rijid endoskop ile çıkarıldı. Özefagus yabancı cisimleri, vakit kaybetmeden çıkarılmalıdır. Özefagus perforasyonlarında klasikyaklaşım erken vakalarda primer tamir ve geç vakalarda rezeksiyon ve anastomozdur.. Kliniği stabilhastalar non-operatif takip edilebilir; endoskopik stent ve klip uygulama ve perkütan abse drenajıile major cerrahi gereksinimi azaltılabilir. Fleksibl endoskopi keskin kenarlı özefagus yabancı cisimlerini çıkarmada yetersiz kalırsa, rijid endoskopi daha uygun olabilir.

Importance of Rigid Endoscopy in Esophageal Sharp Foreign Bodies

Esophageal perforations are emergent cases. They may be iatrogenic, spontaneous or becauseof foreign body. The first diagnostic tool and intervention are imaging and flexible endoscopyin the case of foreign body. Flexible endoscopy is easy to use, widely available and has a lowcomplication rate. Rigid endoscopy needs experience and general anesthesia.54-years-old female patient came with the complaint of goose bone piece impaction in esophagus.Direct graphs showed the foreign body in cervical esophagus. Flexible endoscopy failed andcontrol CT revealed free air around cervical esophagus and perforation. It was removed by rigidendoscopy. Esophageal foreign bodies must be removed immediately. If perforation occurs, main approachis primary repair in early and, resection and anastomosis in late ones. Non-operative treatmentmay be tried in clinically stable patients. Endoscopic stenting, clip application, and percuatenousabcess drainage may decrease surgery need. If flexible endoscopy fails, rigid endoscopy may bemore appropriate.

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