Mide Perforasyonu ve Tedavisi
Özet
Mide perforasyonu, mide duvarının tam kat yaralanması olup, yüksek morbidite (%50) ve mortalite (%30) oranlarına sahip, acil cerrahi müdahale gerektiren ciddi bir klinik tablodur. En sık peptik ülser hastalığına sekonder gelişmekle birlikte travma, maligniteler, iatrojenik endoskopik işlemler ve kardiyopulmoner resüsitasyon gibi nedenlerle de meydana gelebilir. Özellikle Helicobacter pylori enfeksiyonu ve non-steroid anti-inflamatuar ilaç (NSAİİ) kullanımı en önemli agresif faktörler arasında yer almaktadır. Ramazan ayındaki gibi 12 saati aşan uzamış açlık durumları da perforasyon riskini artırmaktadır. Hastalık tipik olarak ani başlayan şiddetli karın ağrısı, distansiyon ve peritoneal bulgularla kendini gösterir; diyafram irritasyonuna bağlı olarak omuz ağrısı da eşlik edebilir. Tanıda fizik muayene ve hikayenin yanı sıra laboratuvarda lökositoz, radyolojik olarak ise direkt akciğer grafisi veya altın standart olan bilgisayarlı tomografide (BT) serbest hava görülmesi kritik rol oynar. Tedavide, altın standart olan açık laparotominin yerini günümüzde postoperatif ağrıyı ve hastanede kalış süresini azaltan laparoskopik primer kapama (Graham rafi) yöntemi almıştır. Ameliyat sonrası süreçte antiasit ve H. pylori eradikasyon tedavileri uygulanır. Proton pompa inhibitörlerinin (PPİ) yaygınlaşmasıyla insidansı azalsa da, geç tanı alan vakalarda peritonit, sepsis ve çoklu organ yetmezliği gibi ölümcül komplikasyonlar gelişebilmektedir.
Gastric perforation is a full-thickness injury of the stomach wall, representing a severe clinical condition with high morbidity (50%) and mortality (30%) rates that requires emergency surgical intervention. Although it most frequently develops secondary to peptic ulcer disease, it can also occur due to trauma, malignancies, iatrogenic endoscopic procedures, and cardiopulmonary resuscitation. Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are among the most critical aggressive factors. Prolonged fasting exceeding 12 hours, such as during Ramadan, also increases the risk of perforation. The condition typically presents with sudden-onset severe abdominal pain, distension, and peritoneal signs, frequently accompanied by shoulder pain due to diaphragmatic irritation. In addition to physical examination and medical history, the detection of leukocytosis in laboratory tests and free air on chest X-rays or computed tomography (CT)—the gold standard—plays a critical role in diagnosis. Regarding treatment, laparoscopic primary closure (Graham patch repair), which reduces postoperative pain and hospital stay, has largely replaced open laparotomy. Postoperatively, antacid therapy and H. pylori eradication are administered. Although its incidence has decreased with the widespread use of proton pump inhibitors (PPIs), delayed diagnosis can lead to fatal complications such as peritonitis, sepsis, and multi-organ failure.
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