Sigmoid volvulus sonrası tanı konulan diyafram evantrasyonu ve çoklu organ anomali birlikteliği

Doğumsal diyafram evantrasyonu ve otozomal dominant polikistik böbrek diğer organ ve sistem tutulumlarının da eşlik edebildiği hastalıklardır. Daha önceden bilinen herhangi bir hastalığı, geçirilmiş travma ya da cerrahisi olmayan 84 yaşında erkek hastanın 2 gündür solunum sıkıntısı, gaz gaita yapamama, karın ağrısı, karında şişlik, bulantı-kusma şikayetleri varmış. Son birkaç saat içinde karın ağrısında şiddetlenme ve ani solunum yetmezliği gelişmesi üzerine başvurdu. Bilgisayarlı tomografide sigmoid volvulus, içi boş organ perforasyonu, dekstrokardi, diyafram evantrasyonu, karaciğer ve böbreklerde multipl kistler saptandı. Hastaya sigmoid rezeksiyon ve kolostomi açılması işlemi uygulandı. Ameliyat sonrası erken dönemde genel durumu düzelen hasta 4. günde sorunsuz şekilde taburcu edildi. Birden fazla sistemi ya da organı tutan patolojiler hastanın kliniğinde beklenenden daha hızlı ve gürültülü bozulmaya sebep olabilmektedir. Böyle hastaların bir bütün olarak değerlendirilmesi tedavinin daha doğru planlanmasını, böylece hastada morbidite ve mortaliteyi artırabilecek gereksiz işlemlerin önüne geçilmesini sağlayacaktır.

Coexistence of diaphragm eventration and multiple organ anomalies diagnosed after sigmoid volvulus

Congenital diaphragm eventration and autosomal dominant polycystic kidney disease are disorders which may be accompanied by other organ and system involvements. An 84-year-old male patient, who had not have a history of any known diseases and previous trauma or surgical procedures, had had complaints of labored breathing, inability to pass gas and stool, abdominal pain, abdominal swelling, nausea and vomiting for the last two days. The patient presented to our clinic as his abdominal pain deteriorated and had sudden respiratory distress within the last couple of hours. Computerized tomography showed sigmoid volvulus, hollow organ perforation, dextrocardia, diaphragm eventration, and hepatic and renal polycysts. The patient received sigmoid resection and colostomy opening procedures. The patient, whose general condition improved in the early post-operative period, was discharged on the 4th day without any problems. Pathologies involving multiple systems or organs can cause a more rapid and noisy deterioration in the patient’s clinic than expected. The evaluation of the cases of such patients as a whole will enable a more accurate treatment planning and thus prevent unnecessary procedures which may increase the risks of morbidity and mortality in these patients.

Keywords:

dextrocardia, eventration, polycystic sigmoid volvulus,

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1. Kabiri el H, Zidane A, Arsalane A, Antoini F. Right diaphragmatic eventration associated with dextrocardia, hypoplasia of the right lower pulmonery lobe and agenesis of the inferior vena cava. J Thorac Cardiovasc Surg. 2007;133:1380-1.
2. Tiryaki T, Livanelioglu Z, Atayurt H. Eventration of the diaphragm. Asian J Surg. 2006;29:8-10.
3. Rajev C, Dharmendra S, Paras K, Siddharth S, Roy CS, Manjula J. Congenital cystic adenomatoid malformation with ipsilateral eventration of the diaphragm. Indian J Pediatr. 2006;73:832-4.
4. Kaehny WD, Everson GT. Extrarenal manifestations of autosomal dominant polycystic kidney disease. Semin Nephrol. 1991;11:661-70.
5. Miyano G, Yamoto M, Kaneshiro M, Miyake H, Morita K, Nouso H et al. Diaphragmatic eventration in children: laparoscopy versus thoracoscopic plication. J Laparoendosc Adv Surg Tech A. 2015;25:331-4.
6. Ali Shah SZ, Khan SA, Bilal A, Ahmad M, Muhammad G, Khan K et al. Eventration of diaphragm in adults: eleven years experience. J Ayub Med Coll Abbottabad. 2014;26:459-62.
7. Kulkarni ML, Sneharoopa B, Vani HN, Nawaz S, Kannan B, Kulkarni PM. Eventration of the diaphragm and associations. Indian J Pediatr. 2007;74:202-5.
8. Özkan S. Diyafram evantrasyonu ve cerrahi tedavisi. J Clin Anal Med. 2014;88-8.
9. Shields TW. Diaphragmatic function, diaphragmatic paralysis and evantration of the diaphragm. in General Thoracic Surgery (Ed TW Shields):607-11. Baltimore, Williams and Wilkins, 1994.
10. Tsunoda A, Shibusawa M, Koike T. Volvulus of the sigmoid colon associated with eventration of the diaphragm. Am J Gastroenterol. 1992;87:1682-3.
11. Nathani N, Iles PB. Acute respiratory failure with an abnormal chest radiograph. Respiration. 2005;72:205–9.
12. Weber TR, Tracy TF, Jr, Silen ML. The diaphragm: Developmental, traumatic, and neoplastic disorders. In Glenn's Thoracic and Cardiovascular Surgery. 6th ed. (Eds AE Baue, AS Geha, GL Hammond, H Laks, KS Naunheim, WL William):618-9. Stamford CT, Appleton and Lange, 1996.
13. Morris-Stiff G, Coles G, Moore R, Jurewicz A, Lord R. Abdominal wall hernia in autosomal dominant polycystic kidney disease. Br J Surg. 1997;84:615-7.