GÖKMEN KURT, Ayşenur CERRAH CELAYİR, Ceyhan ŞAHİN

Uç Kardeşte Duodenojejunal Atrezi

Giriş ve amaç: Intestinal atreziler arasında duodenal atrezi ve yüksek jejunal atreziler yenidoğan barsak tıkanıklıklarının yaklaşıkyarısını oluştururlar. Literatürde üst seviyesi duodenumda alt seviyesi jejunum veya ileumda olan barsak atrezilerinin nadir olması nedeniyle, intestinal atrezi nedeniyle opere edilmiş olan kardeş olgu irdelenmiştir. Gereç ve yöntem: Yenidoğan döneminde intestinal atrezi nedeniyle opere edilen üç kardeş olgu atrezi seviyeleri, atrezi tipi, ameliyat öncesi ve sonrası yapılan tetkikler, postoperatif bakım, hastanede kalış süresi ve altta yatan olası patolojiler açısından değerlendirildi. Bulgular: 1998 'de 2700 gram doğan kız olguda bir başka merkezde Tip II Duodenal atrezi saptanarak duodenojejunustomi yapılmıştır. 2004 yılında prenatal takiplerinde yüksek jejunal obstruksiyon nedeniyle takip edilen kız olgu 2850 gram olarak hastanemizde doğdu. Tip II Yüksek jejunal atrezi saptanan olgudajejunujejunustomi yapıldı. Prenatal dönemde duodenal obstruksiyon düşünülen erkek olgu 36 haftalık iken 2600 gram olarak hastanemizde doğdu. Ameliyatta Tip IIIb duodenojejunal atrezi olduğu saptandı, çapfarkının çokfazla olması nedeniyle uçyan anastomozyapıldı. Üçüncü kardeş olgunun ameliyatı sonrası üç kardeşe de kistikfibrozis açısından ter testi, eCl3 ve idrarda redüktan madde incelemeleri yapıldı, sonuçlar negatif olarak değerlendirildi. Sonuç: Ailenin üç çocuğunda da yüksek intestinal atrezi olması ailesel intestinal atrezi olasılığını düşündürmektedir. İki olguda tıkanıklık seviyesinin duodenumda olması nedeniyle ameliyat öncesi ön tanılar duodenal atrezi olmakla birlikte duodenojejunal atrezi olduğunu göstermektedir. Prenatal dönemde yüksek intestinal obstruksiyon saptanan kardeş olgulardafamilyel intestinal atrezi olasılığı akılda tutulmalıdır.

Three children with duodenojejenal atresia from onefamily

Objective: Duodenal atresia and high leveljejunal atresia represent approximately 50% of the intestinal obstructive cases in newborns. Intestinal atresias with proximal level at duodenum and the distal level at jejenum or ileum are rarely represented in literature. Therefore sisters and brother which had been operated because of intestinal atresia are discussed in this study Material and Methods: Two sisters and one brother who had been operated in newborn period due to intestinal atresia have been analyzed according to following parameters: level of atresia, type of atresia, preoperative andpost operative diagnosis, findings of examination, postoperative care, duration ofhospital stay and the predisposing factors. Results: female patient who was born 2700 gr in 998 had been with duodenojejenostomy due to diagnosis of Tvpe II duodenal atresia in diflerent medical center. Sister ofthefirst case with prenatal diagnosis of high level jejunal obstruction was born 2850 gr in 2004. She had been operated and jejunojejunostomy was performed due to Type 11 high leveljejunal atresia diagnosis. male patient was born in our hospital while he was born at 6.gestational weeks with suspicion of duodenal obstruction in prenatal follow up. During the operation Type IIIb duodenojejunal atresia was found and end to side anastomosis was made because ofhuge differences in diamaters. After the thirdpatients operation both two sisters and brother had been investigated sweat chloride testfor cystic fibrosis, eCl3 and urinary reductant substances and all results were obtained negative. Conclusion: High level intestinal atresia the presence ofin three children proves that axistence ofintestinal atresia infamilial. Before the operation presumtive diagnosis were duodenal atresia due to level ofobstruction were begunfrom duodenum in two patients: but all three patients were found with duodenojejunal atresia in operation: it should be considered that the possibility offamilia] intestinal atresia in case of high level intestinal obstruction in family members in prenatalperiod.

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