Kolon Obstrüksiyonu
Özet
Kolon obstrüksiyonu (kalın bağırsak tıkanıklığı), kolon içeriğinin mekanik nedenler veya motilite bozuklukları sebebiyle kısmen ya da tamamen engellenmesiyle oluşan, hızlı tanı ve müdahale gerektiren acil bir klinik tablodur. Tüm intestinal obstrüksiyonların yüzde yirmi beşini oluşturan bu durum, zamanında tedavi edilmezse bağırsak nekrozu, perforasyon, peritonit ve sepsis gibi yüksek mortaliteye yol açabilen ciddi komplikasyonlara neden olur. Kolon obstrüksiyonlarının en yaygın sebebi kolorektal kanserler (%50'den fazlası) olup, bunu sigmoid veya çekal volvulus (%10-17) ve divertikülit (%10) gibi patolojiler izlemektedir. Hastalar genellikle karın ağrısı, bulantı, kusma, abdominal distansiyon ve gaz-gaita çıkaramama semptomlarıyla başvururlar. Tanı aşamasında fizik muayenenin yanı sıra ayakta direkt batın grafisi ve bilgisayarlı tomografi gibi görüntüleme yöntemleri altın standarttır. Tedavi yaklaşımı ise hastanın sıvı-elektrolit dengesinin düzeltilmesini amaçlayan resüsitasyon aşaması ile başlar. İskemi, perforasyon veya strangülasyon varlığında acil laparotomi gerekirken; hastanın durumuna ve tıkanıklığın lokalizasyonuna göre sağ hemikolektomi, Hartman prosedürü, primer anastomoz veya palyatif amaçlı endoskopik stent uygulamaları tercih edilmektedir.
Colon obstruction (large bowel obstruction) is an emergency clinical condition characterized by the partial or complete blockage of colonic passage due to mechanical causes or motility disorders. Accounting for twenty-five percent of all intestinal obstructions, this condition requires rapid diagnosis and intervention; otherwise, it leads to severe complications such as bowel necrosis, perforation, peritonitis, and sepsis, which carry high mortality rates. Colorectal cancers constitute the most common cause of colon obstructions (more than 50%), followed by sigmoid or cecal volvulus (10-17%) and diverticulitis (10%). Patients typically present with symptoms including abdominal pain, nausea, vomiting, abdominal distension, and the inability to pass gas or stool. In addition to physical examination, imaging modalities such as upright abdominal X-ray and computed tomography are the gold standard for definitive diagnosis. The management approach begins with a resuscitation phase aimed at correcting the patient's fluid and electrolyte imbalances. Emergency laparotomy is mandatory in the presence of ischemia, perforation, or strangulation. Depending on the patient's medical status and the localization of the obstruction, surgical options such as right hemicolectomy, Hartmann's procedure, primary anastomosis, or palliative endoscopic stent applications are utilized.
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