Nekrotizan Enterokolit ve Spontan İntestinal Perforasyon

Öz Nekrotizan enterokolit (NEK) yenidoğan bebeklerde görülen en önemli gastrointestinal acil durumlardan biridir. İntestinal mukozanın iskemik nekrozu ile karakterizedir.Her 1000 canlı doğumda 1-3 oranında görülebilen NEK, yenidoğan yoğun bakımlara yatışların % 1-7,7’sinden sorumludur. İnsidansı, doğum ağırlığı ve gebelik yaşıarttıkça azalır. Spesifik bulgular hastalığın progresyonu ve altta yatan patojenik faktörlere göre değişiklik gösterir. Nekrotizan enterokolit patogenezi tam bilinmemektedir ancak olasılıkla mukozal hasar ile sonuçlanan çoklu faktörlerin neden olduğu heterojen bir hastalıktır. Prematürite, mikrobial fazla çoğalma, beslenme, bozuk mukozal savunma, intestinal kanalın bozulmuş dolaşımı, mukozal hasara ve mikrobiyal fazla çoğalmaya ve intestinal mukoza hasarına sebep olan ilaçlar patogenezde roloynar. NEK’in klinik bulguları sistemik ve abdominal bulgulardan oluşur. Nekrotizan enterokolit tanısı abdominal distansiyon, rektal aşikâr ya da gizli kanama gibikarakteristik klinik bulguların varlığı ve abdominal radyolojik bulgulara dayanır. NEK ayırıcı tanısında rektal kanama, abdominal distansiyon, gastrik retansiyon veya intestinal perforasyon yapan durumlar yer alır. Spontan intestinal perforasyon (SIP) NEK ayırıcı tanısında düşünülmelidir. İzole bir perforasyon olan SİP tipik olarak terminal ileumda görülür. Nekrotizan enterokolit ve SİP’un klinik ve laboratuar bulguları ve tedavi yaklaşımlarında farklılıklar vardır ve ayırıcı tanının yapılması önemlidir. Tıbbi tedavi NEK’ten şüphelenildiği anda acilen başlanmalıdır. Acil yaklaşım destek tedavi, antibiyotik tedavisi ve yakın laboratuar ve radyolojik takibi kapsar. Yenidoğan yoğun bakımındaki ilerlemeler, erken tanı ve agresif tedavi; NEK’li bebek-lerde prognozu iyileştirmiştir ancak halen önemli bir morbidite nedenidir. Prematüreliğin önlenmesi, anne sütü ile beslenme, korioamniyonit ve neonatal enfeksiyonların önlenmesi NEK için koruyucu önlemlerdir.

Anahtar Kelimeler:

nekrotizan enterokolit, spontanintestinal perforasyon

Necrotizing Enterocolitis and Spontaneous Intestinal Perforation

AbstractNecrotizing enterocolitis (NEC) is one of the most common gastro intestinal emergencies in the newborn infant. It is a disorder characterized by ischemic necrosis of the intestinal mucosa. It occurs in 1 to 3 per 1000 live birthsand it is responsible of 1 to 7.7 percent of admissions to neonatal intensive care units. Incidence of NEC decreases withincreasing gestational age and birth weight and is about 6 to 7 percent in very low birth weight infants. The specificfindings vary on the progression of the disease and the presence of underlying pathogenic factors. The pathogenesisof NEC is still unknown, but it is probably a heterogeneous disease resulting from multiple factors that result in mucosal injury. Prematurity, microbial bowel overgrowth, feeding, impaired mucosal defense, circulatory instability ofthe intestinal tract, medications that cause intestinal mucosal injury or microbial overgrowth may play role in the pathogenesis. The clinical presentation of NEC consists of systemic and abdominal signs. The diagnosis of NEC dependson characteristic clinical findings such as rectal bleeding,abdominal distension and radiologic findings. The differential diagnosis of NEC includes the conditions that cause rectal bleeding, abdominal distension, gastric retention, or intestinal perforation. Spontaneous intestinal perforation (SIP) should be considered in differential diagnosis of NEC.Spontaneous intestinal perforation is an isolated perforation of the newborn, typically found at the terminal ileum.There are differences between NEC and SIP for etiology,clinical and laboratory findings and management approac-hes. It is important to make differential diagnosis between these two antities. Medical treatment should be initiated immediately when NEC is suspected. Medical management consists of supportive therapy, antibiotic therapy,and laboratory and radiological monitoring. The prognosis of NEC has improved by neonatal intensive care advances in early diagnosis and aggressive treatment but it hasstill significant morbidity. Preventive measures for NEC arepreventing prematurity, breastfeeding and prevention of chorioamnionitis and neonatal infections.

Keywords:

necrotizing enterocolitis, spontaneous intestinal perfora-tion,

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