Ýnternal abdominal hernilerdeki taný karýþýklýðýnýn çözülmesi

AMAÇ: Ýnternal herniler, gastrointestinal sistemin mezenterik veya peritoneal defektlerle iliþkilendirilen baðýrsak herniasyonlarýdýr. Etyolojik olarak, internal herniler genellikle konjenital veya edinsel olarak iki kategoriye ayrýlýr. Ýnternal herniler genellikle nonspesifik semptomlarla baþvururlar. Bilgisayarlý tomografinin yaygýnlaþmasý ile tanýsal zorluklar azalmýþ olsa da görüntüleme bulgularý ile taný doðruluðu arasýnda yaþanan uyumsuzluk klinisyenler için hala sorun olmaya devam etmektedir. Bu çalýþma ile, acil servise karýn aðrýsý þikayetiyle baþvuran ve bilgisayarlý tomografi (BT) ile internal herni ön tanýsý alan hastalarýn laparotomi sonucu sonlanýmlarýnýn karþýlaþtýrýlmasýný amaçladýk.
GEREÇ VE YÖNTEM: Araþtýrmamýz retrospesktif, gözlemsel ve tanýmlayýcý bir araþtýrmadýr. Araþtýrmamýza acil servise karýn aðrýsý ile baþvuran, BT çekilerek internal herni ön tanýsý alan hastalar dahil edilmiþtir. Hasta verisi olarak: hastalarýn yaþ, cinsiyet, BT ile belirlenen internal herni tipi, ameliyat olup olmadýðý, ameliyat tanýsý, hastane yatýþýnýn olup olmadýðý, yatýþ olduysa kaç gün yattýðý, baðýrsak rezeksiyonu, mortalite ve kan parametreleri kaydedilmiþtir. Ýnternal herni tipi için Welch sýnýflamasý kullanýlmýþtýr.
BULGULAR: Abdomen BT sonucunda internal herni ön tanýsýna sahip olan 112 hastanýn yaþlarýnýn median deðeri 52 yýl olarak bulundu (46 kadýn, 66 erkek). Tüm hastalardan 87 tanesi takip ve operasyon için hastaneye yatýrýlýrken 25 hasta acil servis takibi sonrasýnda taburcu edildi. Paraduodenal herniler 48 hasta ile en çok düþünülen ön taný oldu. Bu hastalardan 45 tanesine acil servis ve klinik gözlem sonrasýnda þikayetlerinin geçmesi üzerine elektif þartlarda deðerlendirilmek üzere taburcu edilmiþtir. Bu hastalarýn kesin tanýsý bilinmemektedir. 32 hastanýn cerrahi sonrasý tanýsý internal herni olarak doðrulanmýþtýr. Bunlardan 15 tanesi kadýn, 17 tanesi erkektir. Yaþlarýnýn median deðeri 52'dir. Ýnternal herni tanýsý alan hastalarýn median hastane yatýþ gün sayýsý 5 olarak bulunmuþtur. Konjenital ve edinsel herniler, rezeksiyon iþlemi ve mortalite açýsýndan incelenmiþtir. Edinsel hernilerde rezeksiyon oraný ve mortalite daha fazla olmasýna raðmen istatistiksel fark bulunamamýþtýr. 35 hastanýn ise tanýsýnýn farklý olduðu görülmüþtür. 19 hasta brid ileus, 5 hasta volvulus, 6 hasta apandisit, 1 hasta duodenal perforasyon, 3 hasta jinekolojik malignite, 1 hasta renal malignite tanýsý almýþtýr. SONUÇ: Ýnternal herniler nadir görülen bir durum olsa da mortalite riskinin fazla olmasý nedeniyle erken teþhis ve tedavi çok önemlidir. Çalýþmamýz sonucunda yaygýnlaþan BT kullanýmý ile daha erken taný ve tedavi þansý yakalayan hastalarýn daha iyi bir prognoza sahip olduðu bulunmuþtur. Çalýþmamýz literatürdeki en fazla vaka serisine sahip çalýþmalardan biridir. Radyolojik görüntüleme ile ön tanýsý internal herni olan hastalarýn deðerlendirildiði, cerrahi sonrasý tanýnýn kesinleþmesi ve internal herni ile karýþabilecek diðer durumlarýn karþýlaþtýrýlmasý ile farklý bir bakýþ açýsý yansýtan, bu sayede literatüre katký saðlayacaðýný düþündüðümüz bir çalýþmadýr.

Untangling diagnostic confusion in internal abdominal hernias

BACKGROUND: Internal hernias involve the herniation of intestines through mesenteric or peritoneal defects in the gastrointestinal system. Etiologically, they are generally classified as congenital or acquired. Internal hernias often present with non-specific symptoms. Despite the increased use of computed tomography (CT), discrepancies between imaging findings and diagnostic accuracy continue to pose challenges for clinicians. This study aims to compare the outcomes of patients presenting to the emergency department with abdominal pain and receiving a preliminary internal hernia diagnosis through CT, followed by laparotomy.
METHODS: Our research is a retrospective, observational, and descriptive study. It includes patients presenting to the emergency department with abdominal pain, who were provisionally diagnosed with internal hernia based on CT. Patient data recorded age, gen-der, CT-identified internal hernia type, surgery, diagnoses, hospitalization status, duration of hospital stay, bowel resection, mortality, and blood parameters. The Welch classification was used to categorize internal hernia types, with eight types examined.
RESULTS: Among 112 patients with a preliminary internal hernia diagnosis based on abdominal CT, the median age was 52 years. Of these, 46 were female and 66 were male. Among all patients, 87 were admitted to the hospital for observation and surgery, while 25 were discharged after emergency department. Paraduodenal hernias were the most common provisional diagnosis (48 cases). Among these patients, 45 were discharged after symptom relief and were advised for elective re-evaluation. The exact diagnosis for these pa-tients remains unknown. Post-surgery, the diagnosis of internal hernia was confirmed in 32 cases. Among them, 15 were female and 17 were male, with a median age of 52. The median hospital stay for patients diagnosed with internal hernia was 5 days. Although acquired hernias exhibited higher resection and mortality rates, no statistically significant difference was found. Thirty-five cases received dif-ferent diagnoses: 19 had brid ileus, five had volvulus, six had acute appendicitis, one had duodenal perforation, three had gynecological malignancies, and one had renal malignancy.
CONCLUSION: Although internal hernias are rare, early diagnosis and treatment are very important due to the high risk of death. The study findings indicate that increased CT utilization leads to earlier diagnosis and treatment, resulting in improved prognosis for patients. This study holds one of the largest case series in the literature. It provides a novel perspective by evaluating radiologically-diagnosed cases, confirming diagnoses post-surgery, and comparing conditions that mimic internal hernias, thereby making a valuable contribution to the literature.