Peptik Ülser Perforasyonlarında Nonoperatif Tedavi ve Literatürün Gözden Geçirilmesi

Yıl 2021, Cilt: 16 Sayı: 3, 365 - 368, 01.11.2021

Ahmet Bozdağ , Barış Gültürk , Ali Aksu , Nizamettin Kutluer , Mehmet Bugra Bozan , Tamer Gündoğdu Abdullah Boyuk

https://doi.org/10.17517/ksutfd.823603

Öz

Amaç: Peptik ülser perforasyonu acil servislerde sık karşılaşılan peptik ülser hastalığının bir komplikasyonudur. Peptik ülser perforasyonlarında non-operatif tedaviden geniş rezeksiyonlara kadar pek çok tedavi seçeneği olmasına rağmen ilk tedavi seçeneği cerrahidir. Bu makalede uygun ve seçilmiş olgularda non-operatif tedavinin uygulanabilirliğini sunmayı amaçladık.
Gereç ve Yöntemler: Kliniğimizde Ocak 2016 – Temmuz 2018 tarihleri arasında cerrahi uygulanmayıp medikal tedavi edilen hastaların verileri retrospektif olarak değerlendirilmiştir.
Bulgular: Hastaların üçü erkek biri kadın ve ortalama yaşları 58 (35-79) idi. Hastaların fizik muayenesinde akut karın bulguları yok sadece sağ üst kadranda ve epigastrik bölgede hassasiyet vardı. Üç hastada ayakta direkt karın grafisinde diyafragma altında serbest hava vardı. Bir hastada ise tanı tomografik bulgularla konuldu. Hiçbir hastada kontrast madde ekstravazasyonu görülmedi. Hastalar uzman bir cerrah tarafından aralıklı muayene edildi ve yatışının 4. Günü orali açılıp ortalama 7. günde hastalar taburcu edilmiştir.
Sonuç: Peptik ülser perforasyonu halen sık karşılaşılan ve akut karın tablosu gelişmiş ise acil cerrahi gerektiren bir durumdur. Her ne kadar perforasyon sonrası geçen süre mortalite ve morbitideyi etkileyen bir faktör olsa da seçilmiş uygun vakalarda suda çözünen kontrast madde ile çekilen BT de ekstravazasyon yoksa ve yaygın peritonit halinin olmadığı, uygun ve seçilmiş hastalarda sıkı fizik muayene ve laboratuar takibi altında başarıyla uygulanabilir bir yöntemdir.

Anahtar Kelimeler

Peptik ülser, Perforasyon, Nonoperatif tedavi

Destekleyen Kurum

yok

Proje Numarası

yok

Nonoperative treatment in peptic ulcer perforations and review of the literatüre

Öz

Background: Peptic ulcer perforation is a complication of peptic ulcer disease frequently encountered in the emergency departments. Although there are many treatment options ranging from nonoperative treatment to wide resections, surgery is the first treatment option in peptic ulcer perforations. In this article, we aimed to present the feasibility of nonoperative treatment in appropriate and selected cases.
Materials and Methods: The data of the patients who were not operated but provided with medical treatment in our clinic between January 2016 and July 2018 were evaluated retrospectively.
Results: Three of the patients were male, one of them was female, and the mean age was 58 years (range, 35-79). On physical examination, there were no signs of acute abdomen, only tenderness was observed in the right upper quadrant and epigastric region. Standing direct abdominal radiography revealed free air under the diaphragm in three patients. The diagnosis was made with tomographic findings in one patient. No contrast agent extravasation was observed in any patient. The patients were examined intermittently by a specialist surgeon, oral intake was permitted on the 4th day of hospitalization, and they were discharged on the 7th day on average.
Conclusion: Peptic ulcer perforation is a condition, which is still common and requires emergency surgery in case of acute abdomen development. Although the time elapsed after perforation is a factor affecting mortality and morbidity, nonoperative treatment is a method that can be successfully applied under strict physical examination and laboratory follow-up in appropriate and selected patients without diffuse peritonitis and extravasation on CT with water-soluble contrast agent.

Anahtar Kelimeler

Peptic ulcer, Perforation, Nonoperative treatment

Proje Numarası

yok

Kaynakça

• 1. Vijayakumar A, Mallikarjuna MN, Vijayraj P, Ajitha Naika, Shivaswamy BS. Non operative management of perforated peptic ulcer an algorithm approach. Int J Biomed Adv Res 2013;4: 67–72.
• 2. Taylor H. Peptic ulcer perforation treated without operation. Lancet.1946;2(6422) :441-444
• 3. Crofts TJ, Park KG, Steele RJ, Chung SS, Li AK. A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med. 1989; 320: 970-973.
• 4. Cao F, Li J, Li A, Fang Y, Wang Y, Li F. Nonoperative management for perforated peptic ulcer: Who can benefit? Asian Journal of Surgery (2014) 37, 148-153
• 5. Taş İ, Ülger BV, Önder A, Kapan M, Bozdağ Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulusal Cer Derg 2015; 31: 20-5
• 6. Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, et al. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer 2012; 12: 26-35.
• 7. Crisp E. Cases of perforation of the stomach with deductions therefrom relative to the character and treatment of that lesion. Lancet. 1843;2639
• 8. Wangensteen OH. Nonoperative treatment of localized perforations of the duodenum. Minn Med. 1935;18: 477- 480
• 9. Songne B, Jean F, Foulatier O, Khalil H, Scotte M. Nonoperative treatment for perforated peptic ulcer: results of a prospective study. AnnChir2004; 129: 578-82.
• 10. Hanumanthappa M.B, Gopinathan S, Guruprasad Rai D, NeilDsouza. A Non-operative Treatment of Perforated Peptic Ulcer: A Prospective Study with 50 Cases, Journal of Clinical and Diagnostic Research. 2012 May (Suppl-2), Vol-6(4): 696-699
• 11. Nusree R. Conservative Management of Perforated Peptic Ulcer. The Thaı Journal of Surgery 2005; 26:5-8.
• 12. Tarasconi, A, Coccolini, F, Biffl, W.L., Tomasoni M, Ansaloni L, Picetti E. et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 15, 3 (2020). https://doi.org/10.1186/s13017-019-0283-9
• 13. Thorsen K, Glomsaker TB, von Meer A, Soreide K, Soreide JA. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. Gastrointest Surg. 2011;15:1329–35.
• 14. Grassi R, Romano S, Pinto A, Romano L. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50:30–6.
• 15. Yeung K-W, Chang M-S, Hsiao C-P, Huang J-F. CT evaluation of gastrointestinal tract perforation. Clinical Imaging. 2004;28:329–33.
• 16. Malhotra AK, Fabian TC, Katsis SB, Gavant ML, Croce MA. Blunt Bowel and Mesenteric Injuries: The Role of Screening Computed Tomography. J Trauma. 2000;48:991–1000.
• 17. Fujii Y, Asato M, Taniguchi N, Shigeta K, Omoto K, Itoh K. et al. Sonographic Diagnosis and Successful Nonoperative Management of Sealed Perforated Duodenal Ulcer. J Clin Ultrasound 2003; 31:1