Vedat NİSANOĞLU, Mehmet YILMAZ, Gökhan SÖĞÜTLÜ, Burak Işık, At All.

KORONER ARTER BYPASS GREFTLEME SONRASI KOLON PERFORASYONU

Kalp cerrahisi sonrası gastrointestinal komplikasyon gelişme olasılığı düşük olmakla birlikte eşlik eden mortalite oldukça yüksektir. Bu komplikasyonlar içinde en mortal seyredeni ise intestinal iskemidir. Bu yazıda, koroner arter bypass greftleme sonrası kolon perforasyonu gelişen; biri mortal seyreden iki olgu sunulmaktadır. Yakın zamanda kalp cerrahisi geçirmiş bir hastada, negatif laparotomi çekincesiyle gecikmek, erken ve tedavi edici bir girişimden çok iskemik intestinal komplikasyonların yaratacağı yüksek mortaliteyi daha da arttıracaktır.

Anahtar Kelimeler:

Kalp cerrahisi, kolon perforasyonu, koroner arter bypass greftleme

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Andersson B, Nilsson J, Brandt J, Hoglund P, Andersson R. Gast- rointestinal complications after cardiac surgery. Br J Surg 2005; 92: 326-333.
D'Ancona G, Baillot R, Poirier B, Dagenais F, de Ibarra JI, Bauset R, Mathieu P, Doyle D. Determinants of gastrointestinal compli- cations in cardiac surgery. Tex Heart Inst J 2003; 30:280-285.
Doguet F, Litzler PY, Tamion F, Richard V, Hellot MF, Thuillez C, Tabley A, Bouchart F, Bessou JP. Changes in mesenteric vascular reactivity and inflammatory response after cardiopulmonary bypass in a rat model. Ann Thorac Surg 2004; 77:2130-2137.
Doty JR, Wilentz RE, Salazar JD, Hruban RH, Cameron DE. At- heroembolism in cardiac surgery. Ann Thorac Surg 2003; 75:1221-1226.
Fitzgerald T, Kim D, Karakozis S, Alam H, Provido H, Kirkpat- rick J. Visceral ischemia after cardiopulmonary bypass. Am Surg 2000; 66:623-626.
Geissler HJ, Fischer UM, Grunert S, Kuhn-Regnier F, Hoelscher A, Schwinger RHG, Mehlhorn U, Hekmat K. Incidence and out- come of gastrointestinal complications after cardiopulmonary bypass. Interact CardioVasc Thorac Surg 2006; 5:239-242.
Ghosh S, Roberts N, Firmin RK, Jameson J, Spyt TJ. Risk fac- tors for intestinal ischaemia in cardiac surgical patients. Eur J Car- diothorac Surg 2002; 21:411-416.
Mangi AA, Christison-Lagay ER, Torchiana DF, Warshaw AL, Berger DL. Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients. Ann Surg 2005; 241:895-901.
McSweeney ME, Garwood S, Levin J, Marino MR, Wang SX, Kardatzke D, Mangano DT, Wolman RL; Investigators of the Isc- hemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. Adverse gastrointestinal complications after cardiopulmonary byass: can outcome be pre- dicted from preoperative risk factors? Anesth Analg 2004; 98: 1610-1617.
Musleh GS, Patel NC, Grayson AD, Pullan DM, Keenan DJ, Fabri BM, Hasan R. Off-pump coronary artery bypass surgery does not reduce gastrointestinal complications. Eur J Cardiotho- rac Surg 2003; 23:170-174.
Ohri SK, Becket J, Brannan J, Keogh BE, Taylor KM. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilization, and intramucosal pH. Ann Thorac Surg 1994; 57:1193-1199.
Sakorafas GH, Tsiotos GG. Intra-abdominal complications after cardiac surgery. Eur J Surg 1999; 165:820-827.
Sanisoglu I, Guden M, Bayramoglu Z, Sagbas E, Dibekoglu C, Sanisoglu SY, Akpinar B. Does off-pump CABG reduce gastro- intestinal complications? Ann Thorac Surg 2004; 77:619-625.
Tao W, Zwischenberger JB, Nguyen TT, Vertrees RA, McDaniel LB, Nutt LK, Herndon DN, Kramer GC. Gut mucosal ischemia during normothermic cardiopulmonary bypass results from blo- od flow redistribution and increased oxygen demand. J Thorac Cardiovasc Surg 1995; 110:819-828.
Yoshida K, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Tokuda Y, Matsuo T. Gastrointestinal complications in patients undergoing coronary artery bypass grafting. Ann Thorac Cardi- ovasc Surg 2005; 11:25-28.
Zacharias A, Schwann TA, Parenteau GL, Riordan CJ, Durham SJ, Engoren M, Fenn-Buderer N, Habib RH. Predictors of gast- rointestinal complications in cardiac surgery. Tex Heart Inst J 2000; 27:93-99.