Sabri ERGÜNEY, Yılmaz ERSAN, Yusuf ÇİÇEK, Ramazan KUŞASLAN, Ahmet BELLİ, Nihat YAVUZ

Duodenal divertikülosis olgularında klinik analiz ve literatürün gözden geçirilmesi

İlerleyen yaş ile daha sıklıkla karşılaşılırsa da duodenal divertikülozis nadir bir klinik antitedir. Üst Gastrointestinal muayenelerde rastlantısal olarak keşfedilen duodenal divertiküller ekseriyetle asemptomatiktir, ancak önemli morbidite kaynağı olabilir. Duodenal divertikül majör duodenal papillanın yakınına yerleşmişse juxtapapiller (periampuller) duodenal divertikül olarak isimlendirilirler. Bu çalışmanın hedefi duodenal divertiküllü hastalarda klinik karakteristikler sıklık klinik bulgular ve tedavi çeşitlemelerini araştırmaktır. Biz 1983-2003 arasında kliniğimizde cerrahi tedavi geçirmiş duodenal divertikül olgularının retrospektif olarak gözden geçirdik. Klinik bulgular ve patolojik sonuçları olguların kayıtlarından öğrenilmiştir. 1983'ten 2003 kadar duodenal divertiküllü 25 hasta kliniğimizde tedavi edildi. Onların yaşları 43-80 yaşları arasında değişiyordu. Ortalama yaşları 58,1 idi. Olguların 15'i kadın (%60) 10'nu erkek idi (%40). Duodenum 2. bölümünde divertiküller 15 (% 60) olguda tespit edildi Duodenum 3. bölümünde divertiküller 6 olguda (%24) ve 4. bölümünde 4 olguda (%16) tespit edildi. Multipl divertiküller sadece 2 olguda bulundu. 9 olguda nüks kolanjit atakları ilerleyici sarılık batın ağrısını kapsayan bilio-pankreatik semptomlar vardı. 3. ve 4. bölümlerin divertiküllü hastalarında batın ağrısı ve kusma ana semptomlardır. Divertikülektomi etkili bir cerrahi işlemdir. Juxtapapiller duodenal divertiküller bilier taş oluşmasında önemli sebep olucu faktörlerdir. Gastrointestinal kanalda, divertikül hastalığının kolon'dan sonra ikinci en sık yerleşim yeri duodenum'dur. Hastalığın klinik olarak önemi, sadece akademik olarak ilginç oluşundan, hastaların hayatını tehdit eden komplikasyonlara kadar değişir. Kolon dışında nadir olması sebebiyle, ekseriya hastaların şikayetlerinin bir duodenal divertikül (DD) kaynaklı olduğu düşünülmeyebilir. Bu da teşhiste gecikmeye yol açar.1,2 Bu retrospektif çalışmada kliniğimizde DD sebebiyle cerrahi tedavi görmüş hastalar irdelenmiştir.

Clinical analysis and review of related literature in cases of duodenal diverticulosis

Background and Design.- Duodenal diverticular disease is an uncommon clinical entity; however, with progressive aging of the population, duodenal diverticulosis is encountered more often. Duodenal diverticula, discovered incidentally in patients during upper gastrointestinal examinations, are usually asymptomatic, but can be the source of significant morbidity. When duodenal divertucula are located near the major duodenal papilla, they are called juxtapapillary (periampullary) duodenal diverticula. The aim of this study was to investigate the frequency, clinical characteristics, findings and possible varieties of treatment of duodenal diverticula in patients with duodenal diverticula. We retrospectively reviewed the cases of duodenal diverticulum undergone surgical treatment between 1983 and 2003. Clinical findings and pathological results were learned from records of cases. Results.- 25 patients with duodenal diverticula were treated at our clinic from 1983 to 2003. Their age was comprised between 43 and 80 years. Mean age of them was 58.1 years. Fifteen of cases were women (60%) while ten were men (40%). The second part of duodenum was involved in 15 cases (60%). The third part of duodenum was involved in 6 cases (24%) and the fourth in 4 cases (16%) Multiple diverticula were found only 2 cases. 9 patients had bilio-pancreatic symptoms including in recurrent episodes of cholangitis, progressive jaundice and abdominal pain. In patients with diverticula of third and fourth part, abdominal pain and vomiting were the main symptoms.Conclusions.- Diverticulectomy is an effective surgical procedure. Juxtapapillary duodenal diverticula are important causative factors in the formation of biliary stones.

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