Sinan CELAYİR, Daver YEKER, Ergün ERDOĞAN, Nüvit SARIMURAT, Topuzlu Gonca TEKANT, Zekeriya İLÇE

Çocukluk çağında kısa barsak sendromu ile ilgili deneyimlerimiz

Masif barsak rezeksiyonu sonucu ya da konjenital barsak kısalığına bağlı malabsorbsiyon olarak tanımlanan kısa barsak sendromu (KBS) daha ziyade yenidoğanların bir hastalığıdır. En sık malrotasyon-volvulus, gastroşizis, intestinal atrezi, nekrotizan enterekolit nedeni ile uygulanan barsak rezeksiyonları sonrası ortaya çıkar. Kısa barsak sendromunda sonuç kalan barsak uzunluğu, ileoçekal valvin mevcudiyeti, barsak motilitesi, beslenmenin toleransı ile paralellik göstermektedir. Ayrıca sonuç parenteral beslenmenin getirdiği başlıca komplikasyonlar olan sepsis ve karaciğer yetmezliği ile de doğrudan bağlantılıdır. Kliniğimizde 20 yıllık period içinde 20 KBS'lu olgu takip ve tedavi edilmiştir. Mortalite %60 olarak saptanmıştır. Kaybedilen olgularda çoğunlukla kalan barsak uzunluğu 30 cm altında ve ileoçekal valvi olmayan veya korunamayan olgulardır. Bu olgular Çocuk Cerrahisinin ilk yıllarında "bakteriyel over-growth" ve sepsise sekonder kaybedilirken son yıllarda total parenteral beslenmeye bağlı sepsis ve karaciğer yetmezliği bağlı kayıplar ön plana çıkmıştır. Halen kliniğimizde KBS'lu olgularda primer hasta kayıp nedenimiz sepsistir.

Experience with short bowel syndrome during childhood

Background and Design.- Short bowel syndrome (SBS) is a disease of neonatal period which appears mostly after massive bowel resection or congenital short bowel. SBS is generally seen after massive bowel resection because of malrotation, volvulus, gastrochisis, intestinal atresia, and necrotising enterocolitis. The clinical outcome is affected by the remained bowel length, presence of ileocecal valve, motility of intestine, bowel adaptation and tolerance of nutrition. The nutrition regimen complicates as septicemia and liver failure. Results.- 20 patients were followed-up during the 20 year period in our institution. The mortality rate was 60%. In these patients the remained bowel length was under 30 cm and ileocecal valve was not present or removed during the surgery. Conclusion.- In the early years of pediatric surgery the most common reason of death was bacterial overgrowth and septicemia. In the last years TPN related septicemia and liver failure are the main problem. However the main reason of mortality is septicemia in our clinic.

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