Nisan 2010
Nadir bir akut karin nedeni: Spontan koledok perforasyonu
A rare cause of acute abdomen: spontaneous choledochus perforation
- Ana Sayfa
- Sayılar
- Nisan 2010
- Nadir bir akut karin nedeni: Spontan koledok perforasyonu...
Özet
Spontan koledok perforasyonu eriskinlerde de nadirde olsa rastlanan ve biliyer peritonite neden olabilen bir durumdur. Kolelitiasis, koledokolitiasis, koledok kistleri ve ampullanin tümörle obstruksiyonu suçlanan etiyolojik faktörler arasindadir. Etiyolojik faktörler olmaksizin eriskinlerde spontan koledok perforasyonu gelismesi oldukça nadir olup, literatürde sadece birkaç vaka ile sinirlidir. Yetmis sekiz yasinda erkek hasta akut karin tablosu nedeniyle ameliyat edildi, distal koledok posterior bölümünde perforasyon alani oldugu görüldü. Kolesistektomi ve perforasyon alanindan T-tüp drenaj uygulandi. Ameliyat sonrasi 14. günde T-tüp dreni çekildi. Iki gün sonra hastada ani baslayan karin agrisi ve insizyonundan safrali içerik geldigi gözlendi. Ikincil laparotomi uygulanan hastada duodenal ülser perforasyonu saptandi ve primer tamir uygulandi. Tamir edilen koledok perforasyon alani tamamen iyilesmisti. Ikinci ameliyattan sonra yogun bakim ünitesinde takip edilen hasta postoperatif birinci ayinda çoklu organ yetmezligi nedeniyle kaybedildi.
Abstract
Spontaneous choledochus perforation in adults leading to biliary peritonitis is an uncommon entity. Cholelithiasis, choledocholithiasis, choledochal cysts, and tumor obstruction of the ampulla have been reported as possible etiologies of the perforation. The spontaneous perforation of the choledochus without etiologic factors, which leads to acute abdomen, is a very rare condition, with only a few cases reported in the literature. A 78?year-old male patient underwent urgent laparotomy because of acute abdomen, and a spontaneous perforation on the posterior side of the distal choledochus was determined. Cholecystectomy and T-tube drainage through the perforation hole was performed. T-tube was removed on the postoperative 14th day. After two days, the patient suffered from acute abdominal pain and bile leakage was observed from the incision line. The second-look laparotomy determined duodenal ulcer perforation, and primary repair was performed. The choledochus was intact. The patient was followed in the intensive care unit after the second operation and died from multiple organ failure in the first postoperative month.
