Mide Çıkım Obstrüksiyonları
Özet
Mide çıkım obstrüksiyonu (MÇO), mekanik bir tıkanıklık sonucu epigastrik ağrı ve yemek sonrası kusma ile kendini gösteren klinik bir sendromdur. Geçmişte peptik ülserler en yaygın nedeni iken, günümüzde asit baskılayıcı ilaçların yaygınlaşmasıyla maligniteler vakaların %50-80'ini oluşturur hale gelmiştir. Etiyolojisi neoplastik, inflamatuar, infiltratif, iyatrojenik ve diğer nadir nedenler olmak üzere beş grupta incelenir. Klinik olarak epigastrik ağrı, kusma ve kilo kaybı sık görülürken; tanıda fizik muayene, laboratuvar testleri, bilgisayarlı tomografi ve üst GİS endoskopisi kullanılır. Tedavide öncelikle hastanın oral alımı kesilir, nazogastrik dekompresyon ve yüksek doz proton pompa inhibitörleri (PPİ) başlanır. Spesifik yaklaşım ise nedene göre değişir: Peptik ülser ve Crohn hastalığında endoskopik balon dilatasyonu veya cerrahi tercih edilirken; kronik pankreatitte bypass cerrahisi gerekir. Malign darlıklarda enteral stentleme ya da palyatif bypass uygulanır. Bouveret sendromu ve polipler gibi nadir nedenlerde ise taş veya polibin çıkarılması esastır.
Gastric outlet obstruction (GOO) is a clinical syndrome characterized by epigastric abdominal pain and postprandial vomiting caused by mechanical obstruction. While peptic ulcer disease was historically the primary cause, the widespread use of acid-suppressing medications has shifted the etiology, making malignancies responsible for 50-80% of current cases. The etiology is classified into five categories: neoplastic, inflammatory, infiltrative, iatrogenic, and other rare causes. Clinically, epigastric pain, vomiting, and weight loss are highly prevalent; diagnosis relies on physical examination, laboratory tests, computed tomography, and upper gastrointestinal endoscopy. Initial management requires restricting oral intake, initiating nasogastric decompression, and administering high-dose proton pump inhibitors (PPIs). Specific treatment varies by etiology: endoscopic balloon dilation or surgery is recommended for peptic ulcers and Crohn's disease, whereas chronic pancreatitis typically requires bypass surgery. Malignant obstructions are managed with enteral stenting or palliative bypass. Rare causes, such as Bouveret syndrome or large gastric polyps, necessitate the removal of the obstructing stone or polyp.
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