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GİRİŞ ve AMAÇ: Yenidoğanlarda intestinal tıkanıklıkların en sık nedenlerinden birisi olan doğumsal duodenal tıkanıklıklar, eşlik eden anomaliler açısından önem arz etmektedir. Bu çalışmada; kliniğimizde opere edilen konjenital duodenal tıkanıklık olgularının sonuçları değerlendirilerek bu hastalardaki deneyimimizin gözden geçirilmesi amaçlanmıştır. YÖNTEM ve GEREÇLER: 2004-2017 tarihleri arasında kliniğimizde doğumsal duodenal tıkanıklık tanısı ile ameliyat edilen hastaların tüm hastane kayıtları geriye dönük olarak incelendi. Hastalar demografik özellikler, klinik bulgular, eşlik eden anomaliler, tedaviler ve sonuçlar açısından değerlendirildi. BULGULAR: On üç yıllık sürede; 36 (%53) erkek, 32 (%47) kız olmak üzere doğumal duodenal tıkanıklık tanılı 68 yenidoğan ameliyat edildi. Ortalama doğum haftası 35.7±3.1 hafta (28-44 hafta), ortalama doğum ağırlığı 2477±651.5 gram (1100–4100 gram) olup 46’sı (%67.7) prematüre idi. Ek anomali olguların 37’sinde (%54.4) mevcut olup bunların 16’sında (%23.5) doğumsal kalp hastalığı, 13’ünde (%19.1) ise Down sendromu mevcuttu. Ek anomalili olgularda ortalama postoperatif enteral beslenmeye geçiş zamanı 9.5±5.8 gün (4-37 gün), ortalama hastane yatış süresi 25.6±26.2 gün (9-140 gün) idi; ek anomalisi olmayanlarda ise bu süreler sırasıyla 7.6±3.2 gün (4-20 gün) ve 17.5±13.7 gün (8-80 gün) olarak saptandı. Sepsis, ileus, beslenme intoleransı gibi postoperatif komplikasyonlar gelişen 17 olgunun (%25) 3’ünde (%4.4) abdominal ikincil ameliyat gerekti. Altmış üç olgu (%92.6) ortalama 21.4±22 gün (8-140 gün) taburcu edilirken, 5 olgu (%7.4) ameliyat sonrası ortalama 27.2±14.1 gün (11-43 gün) eşlik eden ağır doğumsal kardiak malformasyonlar ve sepsis nedeniyle kaybedildi. Kaybedilen hastaların sepsis oranı taburcu olan olgulara göre istatistiksel olarak anlamlı yüksekti (p<0.001). TARTIŞMA ve SONUÇ: Doğumal duodenal tıkanıklık tanılı olgularda ek anomali varlığı, mortalite ve morbidite riskini arttırmaktadır. Ağır kardiak malformasyonlar ve sepsis prognozu kötü yönde etkilemektedir.
Introduction and Purpose: Parental duodenal obstructions, which are one of the most common causes of intestinal blocks in newborns, are important in terms of accompanying anomalies. This study aims to review our experience with these patients by evaluating the results of congenital duodenal obstructions operated in our clinic. Method and Requirements: Between 2004 and 2017, all hospital records of patients who were diagnosed with parental duodenal disorder in our clinic were reviewed backward. Patients were evaluated in terms of demographic characteristics, clinical findings, accompanying anomalies, treatments and results. In the period of thirteen years; 36 (% 53) men, 32 (% 47) girls, 68 newborns diagnosed with parental duodenal obstructions, were operated. The average week of birth was 35.7±3.1 weeks (28-44 weeks), the average birth weight was 2477±651.5 grams (1100-4100 grams) and 46 (67.7%) was premature. Additional abnormalities occurred in 37 (54.4%) and in 16 (23.5%) were congenital heart disease and in 13 (19.1%) Down syndrome. In additional anomalies, the average time of transition to postoperative interal diet was 9.5±5.8 days (4-37 days), the average hospital stay period was 25.6±26.2 days (9-140 days), while in non-additional anomalies, these periods were set as 7.6±3.2 days (4-20 days) and 17.5±13.7 days (8-80 days) respectively. After the development of postoperative complications such as sepsis, ileus, nutritional intolerance, 3 (4.4) of the 17 incidents (25%) needed abdominal secondary surgery. Sixteen three facts (%92.6) in average 21. While 4±22 days (8-140 days) were released, 5 incidents (7.4%) were lost due to severe parental heart malformations and sepsis that accompanied an average of 27.2±14.1 days (11-43 days) after surgery. The sepsis rate of losing patients was statistically significantly higher (p<0.001). NATURAL DUODENAL CONTRACT: In the diagnosed cases, the presence of additional anomalies increases the risk of mortality and morbidity. Heavy heart malformations and sepsis forecast are badly affected.
INTRODUCTION: Congenital duodenal obstruction, which is one of the most common causes of intestinal obstruction in neonates, gain importance in terms of associated anomalies. In this study, we aimed to review our experience with congenital duodenal obstruction cases operated in our clinic while evaluating the results of these patients. METHODS: All hospital records of neonates with congenital duodenal obstruction which had operated in our department between 2004 and 2017 were reviewed retrospectively. Patients were evaluated according to their demographic features, clinical presentations, associated anomalies, treatments and outcomes. RESULTS: During 13 years, 68 newborns (36 males, 32 females) with congenital duodenal obstruction were operated. The mean gestational age was 35.7±3.1weeks (28-44weeks), the mean birth weight was 2477±651.5 gram (1100–4100 gram) and 46 (67.7%) of them were premature. Associated abnormalities were detected in 37 neonates (54.4%); 16 of them (23.5%) had congenital cardiac malformations, and 13 of them (19.1%) had Down Syndrome. In neonates with associated abnormalities; the avarage period to start enteral feeding was 9.5±5.8 days (4-37days) and the mean hospitalization period was 25.6±26.2days (9-140days). These values were found 7.6±3.2 days (4-20days) and 17.5±13.7days (8-80days) respectively for the patients having no associated anomalies. Postoperative complications such as ileus, septicemia and nutritional intolerance were seen in 17 patients (25%); 3 of them (4.4%) need re-operation. While 63 patients (92.6%) were discharged on average 21.4±22 days (8-140 days); due to septicemia and severe congenital cardiac malformations 5 patients (7.4%) were died in 27.2±14.1 days (11-43days) postoperatively. The rate of septicemia was statistically significantly higher in patients with excitus than the ones who were discharged (p<0.001). DISCUSSION AND CONCLUSION: The presence of associated abnormalities in patients with congenital duodenal obstruction increases the risk of morbidity and mortality. Septicemia and severe congenital cardiac malformations adversely affect prognosis.
Field : Sağlık Bilimleri
Journal Type : Uluslararası
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