Mide Kostik Yaralanmaları ve Tedavisi
Özet
Midenin ve özofagusun kostik yaralanmaları, ev temizlik maddeleri gibi koroziv ajanların kazara veya intihar amacıyla yutulması sonucu üst gastrointestinal sistemde meydana gelen ciddi hasarları ve tedavi yaklaşımlarını içerir. Asitler koagülasyon nekrozuna, alkaliler ise likefaksiyon nekrozuna yol açarak akut dönemde perforasyon, ilerleyen süreçte ise striktüre (darlık) neden olabilir. Tanı aşamasında, doku hasarının derecesini belirlemek için ilk 12-48 saat içinde yapılan üst endoskopik değerlendirme, Kikendall veya Zargar sınıflandırmaları rehberliğinde kritik bir rol oynar. Akut tedavi yönetiminde kusturma, nötralizasyon ve aktif kömür uygulamaları perforasyon ile ek yaralanma riskini artırdığı için kesinlikle kontrendikedir. Darlık oluşumunu engellemek amacıyla klinik dereceye göre kortikosteroidler, antibiyotikler veya total parenteral beslenme tercih edilirken; ileri derece perforasyon ve mediastinit vakalarında ise acil cerrahi rezeksiyon ve rekonstrüksiyon ameliyatları zorunludur.
Caustic injuries of the stomach and esophagus encompass severe damages occurring in the upper gastrointestinal tract due to accidental or suicidal ingestion of corrosive agents such as household cleaning products. While acids cause coagulation necrosis, alkalis lead to liquefaction necrosis, posing acute risks of perforation and long-term complications like stricture formation. For diagnosis, upper endoscopic evaluation performed within the first 12-48 hours plays a critical role in determining the severity of tissue damage under the guidance of Kikendall or Zargar classifications. In acute management, inducing vomiting, neutralization, and active charcoal are strictly contraindicated as they increase the risk of perforation and additional injury. To prevent stricture formation, corticosteroids, antibiotics, or total parenteral nutrition are preferred depending on the clinical grade, whereas emergency surgical resection and reconstructive operations are mandatory for severe cases involving perforation and mediastinitis.
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