GÜSBD 2017; 6(2): 83 -89 Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi Derleme GUSBD 2017; 6(2): 83 -89 Gümüşhane University Journal Of Health Sciences Review SMALL BOWEL DISEASES REQUIRING EMERGENCY SURGICAL INTERVENTION ACİL CERRAHİ GİRİŞİM GEREKTİREN İNCE BARSAK HASTALIKLARI Erdal UYSAL1, Hasan BAKIR1, Ahmet GÜRER2, Başar AKSOY1 ABSTRACT ÖZET In our study, it was aimed to determine the main Çalışmamızda cerrahların günlük pratiklerinde, ince indications requiring emergency surgical interventions in barsakta acil cerrahi girişim gerektiren ana endikasyonları small intestines in daily practices of surgeons, and to belirlemek, literatür desteğinde verileri analiz etmek analyze the data in parallel with the literature. 127 patients, amaçlanmıştır. Merkezimizde ince barsak hastalığı who underwent emergency surgical intervention in our nedeniyle acil cerrahi girişim uygulanan 127 hasta center due to small intestinal disease, were involved in this çalışmaya alınmıştır. Hastaların dosya ve bilgisayar kayıtları study. The data were obtained by retrospectively examining retrospektif olarak incelenerek veriler elde edilmiştir. the files and computer records of the patients. Of the Hastaların demografik özellikleri, tanıları, yapılan cerrahi patients, demographical characteristics, diagnoses, girişimler ve mortalite parametreleri kayıt altına alındı. performed emergency surgical interventions, and mortality Elektif opere edilen hastalar ve izole incebarsak hastalığı parameters were recorded. The electively operated patients olmayan hastalar çalışma dışı bırakıldı Rakamsal and those having no insulated small intestinal disease were değişkenler ise ortalama±standart sapma olarak verildi. excluded. The numeric variables are expressed as mean ±standard deviation.The mean age of patients was 50.3±19.2 Hastaların ortalama yaşları 50.3±19.2 idi. Kadın erkek years. The portion of females to males was 0.58. The most oranı 0.58 idi. En sık acil cerrahı girişim 61 (%48) hasta ile frequent emergency surgical intervention was the ince barsak obstruksiyonu nedeniyle yapıldı. En sık ince interventions that were performed due to small intestinal barsak obstruksiyonu nedeni olarak adezyonlar bulundu. obstruction in 61 (48%) patients. The most frequent reason İnce barsak obstruksiyonlarından sonra en sık acil girişim for small intestinal obstruction was found to be the lesions. gerektiren nedenler sırasıyla 28 (%22) hasta ile ince barsak Following the small intestinal obstruction, other most perforasyonları, 18 (%14) hasta mezenter iskemi, 9 (%7) frequent reasons were small intestinal perforation in 28 hasta malign neoplaziler ve 8 (%6) hastada chron (22%) patients, mesentery ischemia in 18 (14%) patients, hastalığına, 3 (%2) hastada benign neoplazmlara bağlıydı. malign neoplasia in 9 (7%) patients, chron disease in 8 (6%) Hastalara en sık yapılan operasyonlar adezyolizis patients, and benign neoplasms in 3 (2%) patients. The most (bridektomi), ince barsak rezeksiyonu ve anastamoz, frequently performed operations were adhesiolysis enterostomi idi. Toplam mortalite sayısı 7 (%5) olarak (bridectomy), small intestine resection and anastomose, and bulundu. Beş hastada mortalite nedeni mezenter iskemiye enterostomy, respectively. The total number of mortality bağlı görüldü. Bunu 2 hasta ile ince barsak perforasyonu was found to be 7 (5%). The cause of mortality was izledi. observed to be mesentery ischemia in 5 patients, followed En sık acil cerrahi girişim ince barsak obstrüksiyonları by small intestinal perforation in 2 patients. The most nedeniyle olmaktadır. Obstrüksiyonların en sık sebebi ise frequently performed emergency surgical intervention is the postoperative adezyonlardı. İnce barsak perforasyonlarının operation performed due to small intestinal obstruction. The en sık sebebi künt ve penetran travmalara bağlı most frequent cause of obstructions was the postoperative perforasyonlardı. Lenfomalar en sık görülen malign ince adhesions. The most frequent cause of the small intestinal barsak tümörü olarak bulundu. Akut mezenter iskemi en perforations was the perforations due to blunt and penetrant fazla mortalitenin görüldüğü ince barsak hastalığı olarak traumas. Lymphoma was found to be the most frequently bulundu. En sık yapılan cerrahi girişim ince barsak seen small intestinal tumor. The acute mesentery ischemia rezeksiyon ve anastamozu idi. was found to be the small intestinal disease with highest mortality rate. The most frequently performed operation was Anahtar Kelimeler: Acil, İnce barsak, Cerrahi, small intestinal resection and anastomosis. İntestinal Obstrüksiyon,Neoplazi, Keywords: Emergencies, Intestine, Small, Surgery, Intestinal Obstruction, Neoplasms 1 Yrd. Doç. Sanko Üniversitesi Tıp Fakültesi Genel Cerrahi Ana Bilim Dalı 2 Uzm. Dr. Sanko Üniversitesi Tıp Fakültesi Genel Cerrahi Ana Bilim Dalı. İletişim / Corresponding Author : Erdal UYSAL Geliş Tarihi / Received : 08.11.2016 e-posta / e-mail: [email protected] Kabul Tarihi / Accepted : 23.02.2017 ~ 83 ~ GÜSBD 2017; 6(2): 83 -89 Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi Derleme GUSBD 2017; 6(2): 83 -89 Gümüşhane University Journal Of Health Sciences Review INTRODUCTION AND OBJECTIVE Nowadays, the surgical interventions to obstruction, perforation, and hemorrhage. small intestines still constitute a problem. Lymphomas, neuro-endocrinal tumors, The most important reason for this is that the sarcomas, and adenocarcinomas are the small intestines are affected from a wide tumors that are seen in small intestines and may lead to the highest rate of emergency range of diseases. Moreover, small intestine 10 is a complex organ having many important surgical intervention. Furthermore, tasks such as digestion, absorbing, secretion, leiomyomas and metastatic tumors may also lead to emergency surgical intervention to and endocrine function. For this reason, the 11-13 small intestinal diseases may lead to life- the small intestines. threatening clinic conditions. Some of the Chron disease is another important disease small intestinal diseases are treated requiring emergency intervention in small medically, while some others may require intestines. Even though its main therapy is surgical treatment. Emergency surgical medical, the causes such as hemorrhage, interventions are performed due to perforation, and structure may also require mechanical obstruction, perforation, emergency surgical interventions.14, 15 ischemia, inflammatory intestinal disease, Acute mesenteric ischemia is a rare clinic and tumors. condition constituting 1 of every 1000 The small intestinal obstruction is the applications to the hospital. The most most frequent cause of emergency surgical frequent reason for it is the obstruction of intervention. The rate of emergency surgical superior mesenteric artery or its branches due intervention is 16%.1 The most frequent thromboembolism. Immediate diagnosis and cause of small intestinal obstruction is the treatment decrease the mortality and postoperative adhesions.2 Among other morbidity rates. The main treatment is causes, the hernias, invagination, tumors, performed via interventional radiology, while parasites, and volvulus can be given as the emergency surgical intervention is examples.3, 4 Small intestinal perforation is required in cases such as acute abdomen, another cause of emergency surgical perforation or necrosis.16 Other rare causes of intervention. Delayed diagnosis and emergency surgical interventions are treatment lead to the increase in mortality. Meckel’s diverticulitis and jejunoileal The most frequent causes for the perforations diverticulosis.17, 18 are the ischemia, foreign bodies, tumors, In our study, it was aimed to determine blunt and penetrant trauma, iatrogenic 5-9 the main indications requiring emergency injuries, and diverticulitis. surgical intervention to small intestines in Small intestinal tumors constitute 1% of daily routines of surgeons, and to analyze the all the gastrointestinal tumors. Despite that data with the support of literature. In parallel they are observed very rarely, they may lead with this objective, our clinic experiences are to life-threatening conditions such as shared. ~ 84 ~ GÜSBD 2017; 6(2): 83 -89 Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi Derleme GUSBD 2017; 6(2): 83 -89 Gümüşhane University Journal Of Health Sciences Review MATERIAL AND METHOD 127 patients, who underwent emergency no insulated small intestinal disease were surgical intervention in our center due to excluded. The duodenal diseases were not small intestinal disease between 2015 and involved. The patients were operated by 4 2016, were involved in this study. The data general surgeons working at our center. The were obtained by retrospectively examining numbers of cases are presented without any the files and computer records of the patients. statistical comparison between the groups. Of the patients, demographical The numeric variables are expressed as characteristics, diagnoses, performed mean±standard deviation. Ethical approval was not required because of the retrospective emergency surgical interventions, and mortality parameters were recorded. The study. electively operated patients and those having RESULTS AND DISCUSSION Mean age of the patients was 50.3±19.2 were diagnosed with physical examinations years. The portion of females to males was and conventional graphs. The most 0.58. The characteristics of patients are frequently performed emergency surgical presented in Table 1. intervention was performed due to the small Table