The approach of ischemic colitis case followed by the lower gastrointesitnal bleeding bleeding
| Autor: | Bahar Büşra Özkan, Yuksel Altinel, Ayca Sultan, Serkan Karaman |
|---|---|
| Rok vydání: | 2017 |
| Předmět: | |
| Zdroj: | Volume: 7, Issue: 1 74-76 Çağdaş Tıp Dergisi |
| ISSN: | 2146-4189 2146-6009 |
| Popis: | Colonic vascular ischemia is commonly seen in the descending colon and causes malnutrition and is to be commensurate with the duration of clinical myocardial ischemia. History of cerebrovascular disease, hypertension, with coronary hearth disease, 68-year-old female patient was followed for about 2 weeks with the occasional massive gastrointestinal bleeding complaint. After ceasing oral intake, fluid and electrolyte replacement and a broad-spectrum antibiotic therapy was established. Abdomen bowel wall thickening of the colon in continuity in the CT results were observed with the open SMA SMV. Follow-up colonoscopy was performed from the dentate line at 5 cm starting hemorrhagic and ischemic segments was seen as an area of about 40 cm long. After hemodynamic deterioration she was underwent emergency surgery because of abdominal sensitivity increase. Hartman procedure was performed. Postop pneumonia and pulmonary embolism were suspected. Candida was observed in urine infection. The sudden improving of the patient's postoperative bleeding from the rectal stump where the staple line was, has evolved on the 7th day. The sponges with the adrenaline stopped the bleeding and the hemodynamic support was stabilized with it. The minimal fluid in pelvis was also monitored by ultrasound . The colostomy was fine following the blood supply to the bowel. Later oral intake was started, the general condition of the patient was improved. But on the postoperative day 12 she had suddenly respiratory and cardiac arrest . Finally, the histopathological examination revealed that the ischemic necrosis and purulent some areas could be selected as a morphologic ischemic and necrotic (the intraoperative peritoneal reflection of the level of false membrane formation at the perforation focus off ischemic colitis). Approximately 20% of similar cases were followed with the clinical practice under medical treatment and surgical approach. Kolonik iskemi vasküler beslenmesi az olması sebebi ile inen kolonda daha sık görülen ve klinik tablo iskeminin süresi ile orantılı bir durumdur. Geçirilmiş SVO öyküsü, HT, KAH olan, 68 yaşında bayan hasta yaklaşık 2 haftadır ara ara olan massive ALT GIS kanaması şikayeti ile takibe alındı. Oral alımı stoplanarak, Sıvı elektrolit replasmanı, geniş spektrumlu antibiyoterapi yapıldı. Abdomen BT sonucunda inen kolon devamlılığında barsak duvar kalınlasması , SMA SMV açık olarak izlendi. Takibinde yapılan kolonoskopide dentate line dan itibaren 5. den başlayan ve yaklaşık 40 cm’e kadar iskemik hemorojik segmenter bir alan izlendi. Medikal tedaviye yanıt vermemesi ve hemodinamisi bozulması, FM de hassasiyet artması üzerine acil operasyona alındı. Hastaya Hartman prosedürü yapıldı.Postop takibinde pnömoni,pulmoner emboli şüphesi ve İYE Candida üremesi gelişen hastanın postop 7. gunde stapler hattında ani rektal stump kanaması gelişti. Adrenalinli spongostan ile kanaması durdu ve hemodinamisi destek tedavi ile stabilize edildi. Kontrol batın USG de pelvik minimal sıvı izlendi. Ostomi takibinde barsak kanlanması gayet iyi idi. Oral alımı başlanan genel durumu iyileşen hasta postop 12. günde aniden solunum aresti ve kardiak arest sonrası ex olmuştur. Histopatolojik inceleme iskemik nekroz ve pürülan bazı alanlar morfoloji seçilemeyecek kadar iskemik, nekrotik (perop perıtoneal refleksiyon hizasında false membran oluşumu, kapalı perforasyon odağı?)saptandı. Takip edilen benzer olguların yaklaşık %20’sinde, medikal tedavi altındayken klinik tablo bozulur ve cerrahi yaklaşım gerektirir. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|