Cemil ÇALIŞKAN, E. AKGÜN, Ö. MAKAY, M.A. KORKUT, H. OSMANOĞLU

Crohn hastalığı ve EÜTF Proktoloji Bilim Dalı deneyimi

Amaç: Crohn hastalığı gastrointestinal sistemin ağızdan anüse herhangi bir segmentini tutabilen yangısal bir hastalıktır. Regionel enterit veya terminal ileit olarak da bilinir. Bu çalışmada Crohn hastalığı ile ilgili deneyimlerimizi gözden geçirmeyi ve meslektaşlarımızla paylaşmayı amaçladık. Gereç ve Yöntem: Bu çalışmada Ocak 1994 - Ağustos 2006 tarihleri arasında kliniğimizde tedavi gören 40 hastanın verileri retrospektif olarak incelenmiştir. Girişim sırasındaki hastalık aktivite skorlaması için Crohn Disease Activity Index (CDAI) kullanılmıştır. Sonuçlar: Hastaların 23'ü kadın 17'si erkek, yaş ortalaması 43' tü. En sık semptom karın ağrısıydı. Hastaların tanı konmasından sonraki takip süreleri ortalama 5 yıldı. En sık cerrahi girişim endikasyonu parsiyel obstrüksiyon olup, en sık hastalık lokalizasyonu ise terminal ileum ve sağ kolondu. Erken dönemde en sık görülen komplikasyon cerrahi alanda ciltaltı enfeksiyonu, geç dönemde kısmi barsak obstrüksiyonuydu. Hastaların ortalama hastanede kalış süresi 15 gün, ortalama takip süresi 40 aydı. Bir olgumuz mortal seyretti. Tartışma: Crohn hastalığının ne tıbbi ne de cerrahi halen bilinen küratif bir tedavi yöntemi yoktur. Crohn hastalığının tedavisinde konservatif yaklaşımlar, komplikasyonlar tedavisi ve hastalık semptomlarına yönelik medikal tedavi metodları ön plana çıkmaktadır. Mümkün olduğunca cerrahi girişimlerden kaçınılması ve cerrahi tedavinin son seçenek olarak komplikasyonların tedavisinde ve acil olgularda tercih edilmesi artık günümüzde kabul görmüş bir yaklaşım biçimidir.

Crohn's disease and Ege University School of Medicine Proctology Department experience

Aim: Crohn's disease is involvement of gastrointestinal tract from mouth to anus which characterized by inflammation. It's known as regional enteritis or terminal ileitis. Aim of this study, to look over our experience about Crohn's disease and share with our colleagues. Patients and Method: We retrospectively analyzed the patients with Crohn's disease between Jan 1994-Aug 2006 and 40 patients were detected. We used Crohn Disease Activity Index (CDAI) to evaluate disease activity score before surgical management was performed. Results: There were 23 female and 17 male with a mean age of 43. The most frequent symptom was abdominal pain. Mean follow-up time until surgery was five years. The most frequent indication for surgery was partial intestinal obstruction and mostly located at the terminal ileum and ascending colon. Surgical site infection and partial intestinal obstruction were observed as the most frequent complication in the early and late postoperative period, respectively. Mean followed-up time after surgical treatment was 40 months and mean hospital stay was 15 days. One case died from septic complications in the postoperative day 15. Discussion: There has not yet been discovered a curative treatment procedure, both surgical and medical, for Crohn's disease. The appropriate management for Crohn's disease includes conservative approach, treatment of complications and medical treatment for recovering the symptoms. Currently, it is the best to avoid from the surgical treatment, it should be considered if there is detected an emergency or complication related to Crohn's disease.

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