Tugan TEZCANER, Birkan BİRBEN, Yahya EKİCİ, Feza Y KARAKAYALI, Aydıncan AKDUR, Merih TEPELİOĞLU, Gökhan MORAY

İnce barsak obstrüksiyonuna yol açan nadir nedenler ve cerrahi tedavi sonuçları

Amaç: Bu çalışmada, ince barsak obstrüksiyonlarının etiyoloji ve cerrahi sonuçları açısından incelenmesi amaçlandı.Gereç ve Yöntem: Merkezimizde Ocak 2001 ile Eylül 2015 tarihleri arasında ileus nedeniyle başvuran hastalar retrospektif kesitsel olarak incelendi. Nadir mekanik ince barsak obstrüksiyonu olan hastalar dahil edildi. Hastalar; demografik özellikleri, etiyoloji, etiyolojiye yatkınlık oluşturan durumlar, tanı çalışmaları, tanı çalışmalarının başarısı, tedavi yöntemleri ve sonuçları açısından incelendi.Bulgular: Belirtilen tarihler arasında 481 hasta mekanik ince barsak obstrüksiyonu nedeniyle ameliyat edildi. Hastaların 13’ünde (%2,8) diğer nedenlere bağlı obstrüksiyon saptandı. Bu hastaların 5’inde bezoar (%1,0), 2’sinde B hücreli lenfoma (%0,4), 1’inde yabancı cisim (%0,2); 3’ünde safra taşı (%0,6), 1’inde gastrointestinal stromal tümör (%0,2) ve bir hastada endometriyozise (%0,2) bağlı ince barsak obstrüksiyon mevcuttu. Cerrahi tedavide ezerek ve sağılarak bezoarın ilerletilmesi, enterotomi, enterolitotomi, segmenter ince barsak rezeksiyonu ve ileoçekal rezeksiyon uygulandı. Ameliyat sonrası tek komplikasyon, bir hastada (%7,69) görülen yüzeyel yara yeri enfeksiyonu idi. İzlem süresinde, 3 hastada (%23,0) insizyonel herni görüldü. Hastaların hiçbirinde ince barsak tıkanıklığı nedeniyle yeniden ameliyat gerekliliği olmadı. Sonuç: İnce barsak obstrüksiyonuna yol açan nadir nedenlerin ameliyat öncesi tanı konulması zordur. Adezyon riski olmayan ince barsak obstrüksiyonlu hastalarda bu nadir etiyolojiler de göz önünde tutularak erken dönemde cerrahi tedavi düşünülmelidir.

Anahtar Kelimeler:

Bezoar, gastrointestinal stromal tümör, safra taşı, tıkanıklık, yabancı cisim

Surgical outcomes of small bowel obstruction caused by rare etiologies

Aim: The aim of this study was evaluaterare causes of small bowel obstruction and outcomes of surgical treatment. Material and Method: We have reviewed medical reports of patients admitted for ileus to our institution between January 2001 and September 2015 in this cross-sectional retrospective study. Demographic features, etiology of small bowel obstruction, predisposition to this etiology, diagnostic studies, surgical procedures and outcomes of surgery were evaluated. Results: There were 481 patients were underwent surgery for mechanical small bowel obstruction during the study period. Of these patients, 13 (2.8%) patients have small bowel obstruction caused by rare etiologies. Small bowel obstruction secondary to bezoar (1.0%) was the most common rare etiology. The others were gallstone ileus (0.6%), Non Hodgin B cell lymphoma (0.4%), foreign body (0.2%), gastrointestinal stromal tumor (0.2%) and endometriosis (0.2%). Milking of bezoar, enterolithotomy, enterotomy, segmentary small bowel resection an ileoceacal resection were performed according to the etiology. The only postoperative complication was superficial wound infection in one patient (7.7%). İncisional hernia occurred in three patients (23.0%) during follow up period. There was no recurrence and reoperation because of small bowel obstruction. Conclusion: Diagnosis of miscellaneous etiologies preoperatively is challenging. Patients with small bowel obstruction without risk of adhesions may require a low threshold for early operative intervention keeping in mind these miscellaneous etiologies.

Keywords:

Bezoar foreign body, gallstone, gastrointestinal stromal tumor, , intestinal obstruction,

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1. Sperry J, Cohen MJ. Acute obstruction. Surg Clin North Am 2014;94:77-96.
2. Foster NM, Mcgory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg 2006;203:170-6.
3. Shelton BK. Intestinal obstruction. AACN Advanced Critical Care 1999;10:478-91.
4. Jackson PG, Raiji M. Evaluation and management of intestinal obstruction. American Family Physician 2011;83:2.
5. Fevang B, Jensen D, Svanes K, Viste A. Early operation or conservative management of patients with small bowel obstruction? Eur Jo Surg 2002; 168;8-9:475-81.
6. Miller G, Boman J, Shrier I, Gordon PH. Etiology of small bowel obstruction. Am Jo Surg 2000;180:33-3.
7. Meier RP, De Saussure WO, Orci LA, et al. Clinical outcome in acute small bowel obstruction after surgical or conservative management. World J Surg 2014;38:3082-88.
8. Tiwari A, Gupta V, Hazrah P, Chaudhary AK, Lal R. Phytobezoar: a rare cause of acute small bowel obstruction in an innocent abdomen. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 2013;26:342-43.
9. Amit Sastry M, Steele J, Cooperman . The Perils of Passover: small Bowel obstruction from a matzah Bezoar. Israel Med Assoc Jl :IMAJ [01 Apr 2014;16:255-6.
10. Reisner RM, Cohen JR. Gallstone ileus: a review of 1001 reported cases. Am Surg 1994; 60:441-6.
11. Doko M, Zovak M, Kopljar M, et al. Comparison of surgical treatments of gallstone ileus: preliminary report. World J Surg 2003;27;:400-4.
12. Scarmato VJ, Levine MS, Herlinger H, et al. Ileal endometriosis: radiographic findings in five cases. Radiology 2000;214:509-12.
13. Singh KK, Lessells AM, Adam DJ, et al. Presentation of endometriosis to general surgeons: a 10-year experience. BJS 1995;82:1349-51.
14. Orbuch IK, Reich H, Orbuch M, Orbuch L. Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis. J Min Inv Gynecol 2007;14:113-5.
15. Abbott S, Nikolousis E, Badger I. Intestinal lymphoma--a review of the management of emergency presentations to the general surgeon. Int J Colrect Dis 2015;30:151-7.
16. Eisen GM, Baron TH, Dominitz JA, et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802-6.
17. Tupesis JP, Kaminski A, Patel H, Howes D. A penny for your thoughts: small bowel obstruction secondary to coin ingestion. J Emerg Med 2004;27;:249-52.
18. Hucl T. Acute GI obstruction. Best Practice & Research Clin Gastroenterol 2013;27:691-707.
19. Daneshmand S, Hedley CG, Stain SC. The utility and reliability of computed tomgraphy scan in the diagnosis of small bowel obstruction. Am Surg 1999;5:922.
20. Taourel P, Fabre J-M, Pradel J, et al. Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. AJR 1995;165:1187-92.
21. Tanaka S, Yamamoto T, Kubota D, et al. Predictive factors for surgical indication in adhesive small bowel obstruction. Am J Surg 2008;196:23-7.
22. Zielinski MD, Eiken PW, Heller SF, et al. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg 2011;212;:1068-76.
23. Hayakawa K, Tanikake M, Yoshida S, et al. CT findings of small bowel strangulation: the importance of contrast enhancement. Emerg Radiol 2013;20:3-9.
24. Jancelewicz T, Vu LT, Shawo AE, et al. Predicting strangulated small bowel obstruction: an old problem revisited. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2009;13:93-9.
25. Markogiannakis H, Messaris E, Dardamanis D, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 2007;13:432-7.
26. Uludağ M, Akgün I, Yetkin G, et al. [Factors affecting morbidity and mortality in mechanical intestinal obstruction]. Ulusal Travma Ve Acil Cerrahi Dergisi=Turk J Travm&Emerg: TJTES, 2004;10:177-84.
27. Cheadle W, Garr E, Richardson J. The importance of early diagnosis of small bowel obstruction. Am Surg 1988;54:565-69.