Benign pnömoperiton: Olgu sunumu
Fleksibl kolonoskopi kolon patolojilerinin tanı, tedavi ve takibinde kullanılan en iyi yöntem olarak kabul edilmektedir. Kolonoskopi sonrası karın ağrısından yakınan her hastada, perforasyondan şüphelenilmelidir. Kolonoskopi sonrası perforasyon sıklığı tanısal amaçlı yapılan kolonoskopide %0.01 ile %0.4 arasında değişmektedir. Yaygın peritoneal irritasyon bulguları olması durumunda cerrahi girişim şarttır. Erken cerrahi girişim birçok yazar tarafından mortalite ve morbiditeyi azaltan en iyi stratejik yaklaşım olarak görülmektedir. Seçilmiş olgularda, peritoneal irritasyon bulguları olmaması durumunda ameliyatsız (non-operative) yaklaşım denenebilir. Geniş olgu çalışmaları incelendiğinde ameliyatsız yaklaşılan olguların tüm kolonik perforasyon olgularının ortalama %1 ila %5'ini oluşturduğu görülmektedir. Bu yazıda, kolonoskopi sonrasında intraperitoneal alanda serbest gaz tespit edilen ve ameliyatsız tedavi edilen olgu sunuldu.
Benign pneumoperitoneum: A case report
Flexible colonoscopy is the gold standard in diagnosis, treatment, and follow-up of colonic pathologies. The acute onset of abdominal pain after colonoscopy may be a clinical sign of colonic perforation. Perforation rate after diagnostic colonoscopies varies between 0.01%-0.4%. If the patient develops signs of peritoneal irritation, the surgical intervention is obligatory. According to the literature, early surgical treatment is the best strategic approach that decreases the morbidity and mortality. Nonoperative treatment could be a choice in selected patients without signs of peritoneal irritation. In large colonoscopy series, only 1-5% of the cases with colonic perforation secondary to the colonoscopy were treated conservatively. We reported a case with colonic perforation after diagnostic colonoscopy which we successfully treated nonoperatively without further need of surgery.
___
- 1) T ulchinsky H, Madhala-Givon O, Wasserberg N, Lelcuk S, Niv Y. Incidence and management of colonoscopic perforations: 8 years' experience. World J Gastroenterol 2006;12:4211-3.
- 2) K orman LY, Overholt BF, Box T, Winker CK. Perforation during colonoscopy in endoscopic ambulatory surgical centers. Gastrointest Endosc 2003; 58:554-7.
- 3) K avic SM, Basson MD. Complications of endoscopy. Am J Surg 2001;181:319-32.
- 4) Dominitz JA, Eisen GM, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, et al. Complications of colonoscopy. Gastrointest Endosc 2003;57:441-5.
- 5) Mattei P, Alonso M, Justinich C. Laparoscopic repair of colon perforation after colonoscopy in children: report of 2 cases and review of the literature. J Pediatr Surg 2005;40:1651-3.
- 6) Wong SH, Wong VW, Sung JJ. Virtual colonoscopyinduced perforation in a patient with Crohn's disease. World J Gastroenterol 2007;13:978-9.
- 7) Vieira A, Fernandes V, Freitas J. Post-colonoscopic polypectomy pneumoperitoneum successfully treated by paracentesis. Endoscopy 2005;37:782.
- 8) Janes SE, Cowan IA, Dijkstra B. A life threatening complication after colonoscopy. BMJ 2005;330:889-90.
- 9) Yakobi-Shvili R, Cheng D. Tension pneumoperitoneuma complication of colonoscopy: recognition and treatment in the emergency department. J Emerg Med 2002;22:419-20.
- 10) P ham BV, Raju GS, Ahmed I, Brining D, Chung S, Cotton P, et al. Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video). Gastrointest Endosc 2006; 64:113-9.
- 11) Fu KI, Sano Y, Kato S, Fujii T, Sugito M, Ono M, et al. Pneumoscrotum: a rare manifestation of perforation associated with therapeutic colonoscopy. World J Gastroenterol 2005;11:5061-3.
- 12) Crass RA, Tranbaugh RF, Kudsk KA, Trunkey DD. Colorectal foreign bodies and perforation. Am J Surg 1981;142:85-8.
- 13) K arahan Öİ, Kurt A, Baykara M, Coşkun A. İntraperitoneal serbest havanın US ile saptanabilirliği. Tanısal ve Girişimsel Radyoloji 2003;9:60-62.
- 14) Şahin A, Çağa T, Javadı M, İhtiyar E, Yaşar B, Karahüseyinoğlu E, ve ark. Rektal yabancı cisimler. Kolon ve Rektum Hastalıkları Dergisi 1995;5:12-4.
- 15) Hellinger MD. Anal trauma and foreign bodies. Surg Clin North Am 2002;82:1253-60.
- 16) L yons MF 2nd, Tsuchida AM. Foreign bodies of the gastrointestinal tract. Med Clin North Am 1993; 77:1101-14.