Mehmet KAPLAN, N. Mustafa ATABEK, Bülent SALMAN, Osman DURMUŞ, Akif ABBASOV, Xudayar MUSTAFAYEV

Bir olgu nedeniyle sklerozan enkapsüle peritonit

Amaç: Cerrahi Kliniğimizde karşılaştığımız, nadir görülen idiopatik sklerozan enkapsüle peritonitli (SEP) bir vaka takdim edilmekte ve hastalığın klinik tablosu ve cerrahi tedavisi anlatılmaktadır. Makalenin amacı, literatür bilgileri ışığında SEP'in tüm klinik özelliklerinin gözden geçirilmesidir. Olgu sunumu: Hastanın tedavisi; fibröz dokunun çıkarılması, nekrotik bir ileal segmentin rezeksiyonu ve primer anastomozla barsak bütünlüğünün sağlanmasından oluşmaktaydı. Teknik açıdan sonuç iyi olmasına rağmen postoperatif beşinci günde anastomotik ve septik komplikasyonlar gelişti. Hastaya ikinci bir ameliyatla, ileumda anastomoz kaçağının oluştuğu segment ve kalın barsakta nekroz gelişen bir alan stoma şeklinde dışarı alındı. Postoperatif gidiş kötüydü. Abdominal sepsis ve pnömoni nedeniyle hasta kaybedildi. Sonuç: SEP nadir görülmesine rağmen ağır seyreder. En önemli komplikasyonu intestinal obstrüksiyondur. Özet olarak: (1) mümkünse membranın rezeksiyonuna çalışılmalı; (2) barsak yaralanması oluşursa, en proksimaldeki barsak segmenti stoma şeklinde dışarı alınmalı ve parsiyel rezeksiyonlar primer anastomoz edilmemeli, (3) asemptomatik hastalarda cerrahi tedaviden kaçınılmalıdır. İnce barsak obstrüksiyonunun ayırıcı tanısı ve cerrahi tedavisinde SEP mutlaka akla gelmelidir.

Anahtar Kelimeler:

Yaşlı, Erkek, Periton hastalıkları, Peritonit, Cerrahi işlemler, operatif, Ölümle sonuçlanma

A case report of sclerosing encapsulating peritonitis

Objective: We reported a rare case of idiopathic sclerosing encapsulating peritonitis (SEP) observed in our surgical department and described its clinical behavior and surgical treatment. The aim of this article was to review all clinical aspects of SEP in the light of literature. Case report: Treatment of the patient is consisted of removal of fibrous tissue, resection of a necrotic ileal segment and intestinal reconstruction primary anastomosis. From technical point of view the result was good but anastomotic and septic complications arose on fifth postoperative day. The patient was underwent second operation. Disrupted anastomotic segment in the ileum and a necrotic area in the large bowel were brought as stoma. Postoperative course was worse and the patient died due to abdominal sepsis and pneumonia. Conclusion: Though infrequent, but SEP is very severe. The main complication is intestinal obstruction. As a result: (1) resection of the membrane should be attempted when feasible; (2) in case of inadvertent intestinal wound(s), the most proximal one should be brought out as a stoma, and partial resections should not be anastomosed primarily, (3) no surgical treatment is required in asymptomatic patients. SEP should be kept in mind in the differential diagnosis and surgical management of small bowel obstruction.

Keywords:

Aged, Male, Peritoneal Diseases, Peritonitis, Surgical Procedures, Operative, Fatal Outcome,

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