Enver AKBAŞ, Serkan ÖCAL, Abdullah Emre YILDIRIM, Reskan ALTUN, Murat KORKMAZ, Haldun SELÇUK

Kolonun benign anastomoz darlığında rektal mesalazin tedavisi sonrası endoskopik balon dilatasyonu

Anastomoz darlıkları kolorektal cerrahinin bilinen bir komplikasyonu olmasına rağmen benign hastalıklarda komplet kolonik anastomoz obstrüksiyonu nadirdir. Benign darlıklar low-anterior rezeksiyon sonrası yapılan kolorektal anastomozda nispeten sık görülen bir komplikasyondur ve kolorektal anastomozların %5-22’sinde gelişebilir. Günümüzde benign anastomoz darlıklarının tedavisinde ilk seçenek endoskopik girişimlerdir. Çeşitli endoskopik teknikler tarif edilmesine rağmen optimal yaklaşım için kontrollü prospektif çalışma verileri eksiktir. Bu çalışmada ileri derecede anastomoz darlığı gelişmiş ve endoskopik balon dilatasyon uygulanan bir hastanın sunulması amaçlandı. Hastaya bir haftalık rektal mesalazin tedavisinden sonra bir kez ayaktan balon dilatasyonu uygulandı ve darlık giderildi. Rektal mesalazin uygulamasının darlık bölgesindeki inflamutuvar sürece olumlu etkisi oldu ve balon dilatasyon sayısını azalttı. Kolorektal darlıkların tedavisinde endoskopik balon dilatasyon 1985’ten beri kullanılmaktadır. Minimal invaziv bir yöntemdir, başarı oranı yüksektir, güvenle direkt görüş altında yapılabilir, tekrarlanabilir ve hastanede yatış gerektirmez.

Anahtar Kelimeler:

Kolon anastomoz darlığı, mesalazin, kolon balon dilatasyonu

Endoscopic balloon dilatation after rectal mesalazine treatment within an uncertainty of colonic anastomosis

Although anastomotic strictures are a recognized complication of colorectal surgery, complete colonic anastomotic obstruction from benign disease is rare. A benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection and may develop colonic anastomosis in 5%-22% of cases. Today, endoscopic interventions have become the preferred first-line treatment for postoperative large bowel strictures. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials regarding the optimal approach. In this study, a case of severe anastomotic stricture of the colon, during which endoscopic balloon dilatation was performed, is presented. After a one-week course of treatment with rectal mesalazine, the ambulatory patient underwent balloon dilation only once and the stricture resolved. Rectal mesalazine administration had a positive effect on the inflammatory process at the site of stenosis and reduced the number of balloon dilatations. Endoscopic balloon dilatation has been used since 1985 for the treatment of colorectal strictures. It is a minimally invasive method, has a high success rate, can be performed safely under visual control, can be performed repeatedly, and does not require hospitalization.

Keywords:

Kolon anastomoz darlığı, mesalazin, kolon balon dilatasyonu,

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