TÇCD 2011 29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

 

Aım:To evaluale the clinical and prognostic findings of patients who were treated at our clinic for intestinal atresia (IA) within the past 12 years.

 

Patıents And Methods:43 patients who were treated for intestinal atresia at our clinic within a 12-year period were reviewed retrospectively. Sex, gestastional age, birth weight, type of IA, type of operation, associated anomalies, complications and mortality rates were analyzed.

 

Results:Female/male ratio was 24/19. Mean gestasional age and mean birth weight were 36.5 (30-41) weeks and 2361 (1080-4100) grams, respectively. 12 patients (27.9%) had jejunal atresia, 8 patients (18.6%) had duodenal atresia,  8 patients (18.6%) had ileal atresia, 5 patients (11.6%) had duodenal web, 4 patients (9.3%) had jejunal web, 4 patients (9,3%) had colonic atresia and 2 patients (4.7%) had colonic web. Intestional atresia was associated with the cardiovascular system 30.2% (13 patients), the gastrointestinal system 27.9% (12 patients), the urinary system 4.7% (2 patients) and the central nervous system 2.35% (1 patient). Resection and anastomosis were performed in 26 patients (60.5%), enterostomy was performed in 13 patients (30.2%) resection of web was performed in 2 patients (4.7%) and resection-anastomosis and enterostomy were performed in 2 patients (4.7%). 5 patients (11.6%) had intestinal perforation in the preoperative period. 11 patients (25.6%) had sepsis, 4 patients (9.3%) had brid ileus in the postoperative period. Mortality was reported in 15 of 43 patients (34.9%).

 

Conclusıon:Rapid proliferation of the bacteria in the intestinal lumen leads to the invasion of the thinning intestinal tissue that is proximal to the obtruction by these bacteria. Therefore, sepsis appears to be the greatest problem in intestinal atresias nowadays. Newborn sepsis seems to be the most important cause of mortality in intestinal atresias.

 

 

Amaç: Oniki yıllık süre içerisinde kliniğimiz de intestinal atrezi (İA) nedeniyle tedavi edilen olguların klinik ve prognostik faktörlerini değerlendirmek.

Hastalar Ve Yöntem: Son 12 yılda İA nedeniyle tedavi edilen 43 hasta geriye dönük olarak incelendi. Cinsiyet, doğum haftası, doğum kilosu, hastalığın tipi, operasyon tipi, ek anomaliler, komplikasyonlar, mortalite oranları kaydedildi.

Bulgular: Kız/erkek oranı: 24/19 idi. Ortalama doğum haftaları 36.5 (30-41) hafta, doğum kiloları 2361 (1080-4100) gram idi. Hastaların 12’sinde jejunal atrezi (%27,9), 8’inde duodenal atrezi (% 18,6), 8’inde ileal atrezi (%18,6), 5’inde duodenal web, 4’ünde jejunal web (% 9,3), 4’ünde kolonik atrezi (% 9,3) ve 2’sinde kolonik web (%4,7) mevcuttu. 13’ünde (%30,2) kardiak, 12’sinde (%27,9) gastrointestinal sistem, 2’sinde (%4,7) üriner sistem, 1’inde de (%2,35) santral sinir sistemi anomalileri tespit edildi. 26 hastaya (%60,5) rezeksiyon-anastomoz, 13 hastaya (%30,2) stoma çılması, 2 hastaya (%4,7) web eksizyonu ve 2 hastaya da (%4,7) rezeksiyon-anastomoz-stoma açılması uygulandı. Hastaların 5’inde (%11,6) preoperatif dönemde intestinal perforasyon mevcuttu. Postoperatif dönemde hastaların 11’inde (%25,6) sepsis, 4’ünde (%9,3) brid ileus gelişti.4 hastada ise (%9,3) enterokutanöz fistül, intestinal nekroz, stomada darlık, anastomoz hattında darlık gelişti. Mortalite oranı 43 hastada 15 (%34,9) idi.

Sonuç: Barsak lümeni içindeki bakterilerin hızlı proliferasyonu, bu bakterilerce obstrüksiyonun proksimalindeki incelmiş barsak dokusunun hızla invazyonuna neden olur. Bu nedenle intestinal atrezilerde günümüzde de en büyük sorun sepsistir. Yenidoğan sepsisi intestinal atrezilerde mortalitenin en önemli nedenini oluşturmaktadır.