Spontan ince barsak perforasyonları

Abstract

1995-1999 yılları arasında kliniğimize akut karın nedeni ile başvuran ve spontan ince barsak perforasyonu saptanan olgular; yaş, cins, hastaneye başvuru süresi, etyoloji, mortalite ve morbidite yönünden değerlendirildi. Akut karın nedeni ile başvuran 640 hastanın 14'ü (%2.1) spontan ince barsak perforasyonu idi. Yaş ortalamaları 57 olan olguların 3'ü kadın, 9'u erkekti. Hastaneye başvuru süreleri ortalama 4.9 gün idi. Mortalite oranı %21.4, morbidite oranı %35.7 idi. Başvuru anında hesaplanan APPACHE II skoru yaşayan hastalarda ortalama 6.5, ölen hastalarda ortalama 13.3 tür 8 olguda perforasyonun sebebi bilinmezken 6 olguda sebep karsinom metastazı (1), crohn hastalığı (1), divertikülit (1), amiloidozis (1), bezoar (1) ve radyoterapi (1) olarak belirlendi. Beş olguya ostomi, diğerlerine segmenter rezeksiyon-debridman anastoınoz tekniği uygulandı. SİP kliniğimizde sık görülmeyen bir tablodur. Bulgular nonspesifik olduğu için tanı çoğunlukla ameliyatta konulmaktadır. Etyoloji genellikle belirsiz olup, uygun olgularda rezeksiyon ve primer anastomoz güvenle uygulanabilmektedir.

Aim: To analyse the cases admitted to our clinic due to spontaneous small bowel perforation. Material and method: Between 1995-1999, the cases admitted to our clinic for acute abdominal pain and diagnosed as spontanous small bowel perforations were analysed retrospectively. The age, sex, admittance time, etiology mortality and morbidity of these patients were evaluated. Results: 640 patient were admitted in this period and 14 of them were spontanous small bowel perforations (2.1%). Nine of them were male and three were female. Mean age of the patients was 57. Mean admittance time to the hospital was 4.9 days. Mortality rate was 21.4% and morbidity rate was 35.7%. The mean APPACHE II score of the patients died on the admission was 13.3 and survived was 6.5. The causes of the perforation were metastatic carcinoma (1), bezoar (1), radiotherapy (1), crohn disease (1) and amiloidosis (1). The etiology was unknown in 8 patients. Temporary ileostomy was performed in five cases and resection anastomosis was performed in rest of the remaining cases. Discussion and conclusion -Small bowel perforation is an uncommon condition in the clinical practice. The findings of this entity are nonspecific, and the diagnosis is usully made in the operating room. The etiology is mostly unclear. Resection and primary anastomoses can be useful in the suitable cases.