Akut mekanik intestinal týkanýklýklar

AMAÇ
Acil cerrahi polikliniðine baþvuran akut mekanik intestinal týkanýklýk saptanan hastalardaki tedavi modaliteleri ve cerrahi iþlemlerin zamanlamasý ele alýndý.
GEREÇ VE YÖNTEM
Bu çalýþmaya, acil polikliniðe baþvuran ve akut mekanik intestinal týkanma tanýsý konan tüm hastalar dâhil edildi. Sývý resüsitasyona raðmen hemodinamik olarak stabil olamayan hastalar ve fiziksel incelemede peritoneal irritasyon saptanan hastalar acil ameliyat edildi. Hastalar, yapýþýklýða baðlý olanlar Grup 1 ve diðer nedenlere baðlý olanlarda Grup 2 olarak iki gruba ayrýldý. Yirmi dört saat sonraki medikal ve cerrahi uygulamalarý gruplar arasýnda deðerlendirildi.
BULGULAR
Grup 1’deki 22 ve Grup 2’deki 53 hastaya cerrahi tedavi uygulandý. Gruplar arasýnda cerrahi uygulananlar arasýnda istatistiksel olarak fark vardý (p<0,05). Hastaneye baþvurduktan sonra ortalama takip süreleri Grup 1 ve Grup 2 için sýrasýyla 128,3±24,85 ve 43,1±15,51 saatti (p=0,0001). Grup 2’deki hastalarýn %76,6’sýna 24 saatteki takipleri sýrasýnda cerrahi giriþim uygulandý. Oysa ki bu oran Grup 1’de %36 idi (p<0,05).
SONUÇ
Bu çalýþmadan edindiðimiz klinik deneyim yapýþýklýk dýþýnda akut mekanik intestinal týkanýklýk tespit edilen hastalarýn medikal tedavisi ve takibi ilk 24 saat içinde yapýlmalýdýr.

Acute mechanical intestinal obstructions

BACKGROUND
In this study, we evaluated our treatment modality and timing of surgery in acute mechanical intestinal obstruction (AMIO) patients who were admitted to the emergency room.
METHODS
Only patients with the diagnosis of AMIO were included in this study. Surgery was performed in patients with hemodynamic instability despite fluid resuscitation and peritoneal signs upon physical examination. Patients were divided into two groups. Adhesion cases were assigned to Group 1, while non-adhesion cases were assigned to Group 2. The decision to provide surgical or medical therapy was assessed 24 hours (h) after admission.

RESULTS
Twenty-two patients in Group 1 and 53 patients in Group 2 underwent surgical procedures. The difference between the groups was statistically different (p<0.05). The mean monitoring time after admission to the hospital was 128.3±24.85 h and 43.1±15.51 h in Groups 1 and 2, respectively (p=0.0001). In Group 2, 76.6% of the patients who were monitored for over 24 hours required surgery. In contrast, this rate was only 36% in Group 1 (p<0.05).
CONCLUSION
Our clinical experience shows that medical therapy and monitoring over 24 hours is not a good substitute for surgical treatment of AMIO when the obstruction is not due to an adhesion.