Dilek MEMİŞ, Dilek Hekimoğlu ŞAHİN, Atakan SEZER

Nazogastrik tüp ile beslenme sırasında gelişen duodenal nekroz: Olgu sunumu

Akut solunum sıkıntısı sendromu tanısıyla yoğun bakım ünitesinde yatan 45 yaşlarndaki erkek hastada, nazogastrik tüp ile beslenme esnasında geli şen duodenal nekroz olgusu literatür eşliğinde sunuldu. Olaysız geçen birkaç günden sonra, abdominal distansiyon gelişti, laparotomi yapılıp, duodenal nekroz olduğu saptandı. Bağırsaklarda tı kanıklık veya mezenterik damar hasarı yoktu. Hastaya sedasyon sağlamak için verilen yüksek dozda fentanil, midazolam ve inotropik ajan olan dopamin infüzyonu, mukozal perfüzyonun hasarlanması ile gelişen nekrozda büyük katkı faktörü olarak suçlanabilir.

Anahtar Kelimeler:

Enteral beslenme, Erkek, Orta yaşlı, Nekroz

Duodenal necrosis during nasogastric tube feeding: A case report

A case of duodenal necrosis during nasogastric tube feeding in a 45-year-old male patient hospitalized in intensive care unit with a diagnosis of acute respiratory distress syndrome is reported with a review of literature. Abdominal distension developed after several days of uneventful nasogastric tube feeding. At laparotomy patchy necrosis of the duedonum was found without signs of bowel obstruction or impaired mesenteric perfusion. In this case, the large doses of fentanyl, midazolam and dopamine given for sedation, were suspected to be a major contributing factor to the development of the necrosis by impairing mucosal perfusion.

Keywords:

Enteral Nutrition, Male, Middle Aged, Necrosis,

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1. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000;342:1334-49.
2. Slutsky AS. The acute respiratory distress syndrome, mechanical ventilation, and the prone position. N Engl J Med 2001;345:610-2.
3. Kompan L, Kremzar B, Gadzijev E, Prosek M. Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury. Intensive Care Med 1999;25:157-61.
4. Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Crit Care Med 1999;27:1447-53.
5. Marvin RG, McKinley BA, McQuiggan M, Cocanour CS, Moore FA. Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection. Am J Surg 2000;179:7-12.
6. Munshi IA, Steingrub JS, Wolpert L. Small bowel necrosis associated with early postoperative jejunal tube feeding in a trauma patient. J Trauma 2000; 49:163-5.
7. Frey C, Takala J, Krahenbühl L. Non-occlusive small bowel necrosis during gastric tube feeding: a case report. Intensive Care Med 2001;27:1422-5
8. Heyland DK, Tougas G, King D, Cook DJ. Impaired gastric emptying in mechanically ventilated, critically ill patients. Intensive Care Med 1996;22:1339-44.
9. Fargeas MJ, Fioramonti J, Bueno L. Central and peripheral action of GABAA and GABAB agonists on small intestine motility in rats. Eur J Pharmacol 1988;150:163-9.
10. Greenwood-Van Meerveld B, Barron KW. Tonic GABA(A) receptor-mediated neurotransmission in the dorsal vagal complex regulates intestinal motility in rats. Eur J Pharmacol 1998;346:197-202.
11. Gentilini G, Franchi-Micheli S, Pantalone D, Cortesini C, Zilletti L. GABAB receptor-mediated mechanisms in human intestine in vitro. Eur J Pharmacol 1992;217:9-14.
12. Castedal M, Björnsson E, Abrahamsson H. Effects of midazolam on small bowel motility in humans. Aliment Pharmacol Ther 2000;14:571-7.
13. Nagahata Y, Azumi Y, Kawakita N, Wada T, Saitoh Y. Inhibitory effect of dopamine on gastric motility in rats. Scand J Gastroenterol 1995;30:880-5.
14. Holzer P, Painsipp E. Differential effects of clonidine, dopamine, dobutamine, and dopexamine on basal and acid-stimulated mucosal blood flow in the rat stomach. Crit Care Med 2001;29:335-43.
15. Valle L, Pol O, Puig MM. Intestinal inflammation enhances the inhibitory effects of opioids on intestinal permeability in mice. J Pharmacol Exp Ther 2001;296:378-87.