Ömer KATI, Şükrü GÜNGÖR, Yaşar KANDUR, Ahmet Gökhan GÜLER

İnvajinasyonda Tedavi Yaklaşımı: Takip mi, Cerrahi mi?

Amaç: Bu çalışmada, invajinasyon tanısı alan çocuk hastalarda ultrasonografik bulguların cerrahi yaklaşım ile sadece izlem yönetimi kararında etkinliğini analiz etmeyi amaçladık. Gereç ve Yöntemler: 2012-2017 yılları arasında çocuk cerrahisi servisinde izlenen invajinasyon tanılı çocuk hastaların tıbbi kayıtları geriye dönük olarak incelendi. Bulgular: Ortanca yaş 39.5 ± 35.9 (dağılım 2-171) aydı. Elli yedi (% 64) hasta takip edilmiş, geri kalan hastalar (n = 32, % 36) ameliyat edilmişti. Ameliyat geçirmemiş hastaların ortanca yaşı ameliyat geçirenlere göre anlamlı olarak daha yüksekti (52.2 ± 38.4'e karşı 16.75 ± 12.6; p <0.001). Ameliyatsız grupta 20 (%35.1) hastada taburcu olduktan sonra karın ağrısı gelişirken, ameliyat grubundaki hastaların hiçbirinde ameliyat sonrası karın ağrısı gelişmedi. İnvajine segmentin uzunluğu ameliyat edilen grupta anlamlı olarak daha fazla idi (p=<0.001). İnvajinasyonlu bağırsak segmentinin uzunluğuna dayanan bir ROC eğrisi analizi, % 68.8'lik bir duyarlılık ve % 96.5'lik özgüllük ile 41.5 mm’ nin cerrahi sınır uzunluğu olduğunu ortaya koydu. Sonuç: Çalışmamızda önceki çalışmalardan farklı olarak invajinasyon uzunluğunun cerrahi eşiği 4,15 cm olarak revize edildi. Bu nedenle, bu değerin altındaki hastalarda ameliyat için acil bir endikasyon olmayabilir.

Anahtar Kelimeler:

İnvajinasyon, takip, ultrasonografi, uzunluk.

Management of Intussusception: Follow-up or Reduction?

Objective: In this study, we describe the management and outcome of children with intussusception and analyze the sonographic findings that can be used to differentiate transient, self-limited small bowel intussusception from the cases with an indication for surgery. Material and Methods: We retrospectively reviewed the medical records of pediatric patients with the diagnosis of invagination who had been followed up in the pediatric surgery service between 2012-2017. Results: The median age was 39.5±35.9 (range 2-171) months. Among these patients, 57 (64%) had been followed up without surgery, and the remaining patients (n= 32, 36%) had undergone surgery. The median age of patients who had not undergone surgery was significantly greater than that of the patients who had undergone surgery (52.2±38.4 vs. 16.75±12.6; p<0.001). Twenty (35.1%) patients in the non-surgical group had developed abdominal pain after discharge, whereas none of the patients in the surgical group had developed abdominal pain postoperatively. An analysis of the differences between the groups with respect to the length of the invaginated segment revealed that length of that segment were significantly greater in the surgically managed cases (p=<0.001). A ROC curve based on the length of the invaginated intestinal segment revealed that, 41.5 mm was the best cutoff point for invaginated intestinal length, which resulted in a sensitivity of 68.8% and a specificity of 96.5%. Conclusion: In our study, unlike other studies, the surgical threshold of the invagination length was revised as 4.15 cm. Thus, patients below this value may not have an immediate indication for surgery.

Keywords:

Intussusception, follow-up, ultrasonography, length,

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