Pediatrik hastada invajinasyonun ameliyatsız tedavisi

Amaç: Bu çalışmada rektal kanaması ve safralı kusması olmasa da aralıklı ve kolik şeklinde karın ağrısı ilebaşvuran çocuk hastalarda karın grafisinde şüpheli bir görüntü varsa invajinasyon ön tanısının akılda tutulmasıgerektiğini göstermeyi amaçladık.Gereç ve yöntem: Bu retrospektif, tek merkezli, kesitsel tanımlayıcı çalışmada, Pamukkale Üniversitesi TıpFakültesi Çocuk Cerrahisi Kliniği'nde Eylül 2017-Eylül 2020 tarihleri arasında 0-18 yaş arasında invajinasyonnedeniyle takip edilen 33 hastanın kayıtları incelenmiştir.Hastalar demografik veriler, hastaneye yatış süreleri, görüntüleme yöntemleri, pnömotik redüksiyon ve cerrahiyeilişkin veriler açısından değerlendirildi.Bulgular: Ortalama yaş 37,4±18,8 aydı. Hastaların şikâyetlerinin başlamasından hastaneye başvurularına kadargeçen süre 57,3±66,1 saatti. 10 hastada karın grafisinde ileus bulguları vardı. 30 hastada tipik invajinasyonbulgusu olan bir şampanya kadehi görüntüsü vardı. Ultrasonografi 20 hastada mezenter lenfadenopative 3 hastada “leading point” mevcuttu. 1 hastanın ultrasonografisi normaldi ancak bu hastanın karın grafisideğerlendirildiğinde invajinasyon şüphesi vardı. Bu hasta floroskopi altında değerlendirildiğinde pnömotikredüksiyon yapıldı. “Leading point” olan 3 hastanın 1'inde Meckel divertikülü, 1'inde Burkitt lenfoma ve 1'indenörofibrom eksize edildi.Sonuç: Pnömotik redüksiyon cerrahın ameliyathanede, floroskopi altında ve tek başına yapabileceği bir yöntemolduğu için daha çok tercih edilmektedir. Ameliyathanede floroskopi altında pnömotik redüksiyon denenmesininbir diğer avantajı da ileus bulguları olan ve geç gelen hastalarda ameliyatsız tekniği kontrollü bir şekildedenemektir.

Anahtar Kelimeler:

İnvajinasyon, çilek jölesi dışkı, safralı kusma, rektal kanama, kolik ağrısı

Nonsurgical treatment of intussusception in pediatric patient

Purpose: In this study, to show that the pre-diagnosis of intussusception should be kept in mind if there is a suspicious appearance in the abdominal X-ray in pediatric patients with intermittent abdominal pain or discomfort in the form of colic, even though there is no rectal bleeding and bile vomiting.Material and methods: In this retrospective, single-center, cross-sectional descriptive study, we examined the records of 33 patients who were followed up due to intussusception between the ages of 0-18 at Pamukkale University Faculty of Medicine Pediatric Surgery Clinic between September 2017 and September 2020.Patients were evaluated in terms of demographic data, hospital admission times, data on imaging methods, pneumatic reduction and surgery.Results: The average age was 37.4±18.8 months. The time from the onset of the patients' complaints to admission to the hospital was 57.3±66.1 hours. 10 patients had ileus findings on abdominal radiography. 30 patients had the image of a champagne glass, typical of intussusception. Ultrasonography showed mesentery lymphadenopathy in 20 patients, and leading point in 3 patients. Ultrasonography of 1 patient was normal, but when the abdominal radiography of this patient was evaluated, there was a suspicion for intussusception. When this patient was evaluated under fluoroscopy and pneumotic reduction was performed. 3 patients who had leading point. Meckel's diverticulum was detected in 1 of 3 patients, Burkitt's lymphoma in 1, and neurofibroma in 1.Conclusion: Pneumatic reduction is more preferred as it is a method that the surgeon can do in the operating room, under fluoroscopy and alone. Another advantage of trying pneumatic reduction under fluoroscopy in the operating room is to try the nonoperative technique in a controlled manner in patients with ileus findings and late arrivals.

Keywords:

Intussusception, invagination, vomiting, rectal bleeding, colic pain,

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