Gastroduodenal Perforasyonlar
Özet
Gastroduodenal perforasyonlar, çoğunlukla peptik ülser hastalığının (PUH) bir komplikasyonu olarak ortaya çıkan ve acil cerrahi müdahale gerektiren önemli jeneralize peritonit nedenlerindendir. Hastalar genellikle üst karın bölgesinde aniden başlayan, bıçak saplanır tarzda şiddetli bir ağrı ve "tahta karın" muayene bulgusuyla başvururlar. Tanı aşamasında, ayakta çekilen akciğer grafisi diyafram altındaki serbest havayı göstermede %86 sensitiviteye sahip değerli bir yöntemken, bilgisayarlı tomografi en güvenilir tanı aracıdır. Temel tedavi metodu cerrahi olup, Graham omental yama yöntemi hem açık hem de laparoskopik yaklaşımlarda ana metoddur. Perforasyonun kapandığı seçilmiş vakalarda nazogastrik dekompresyon ve proton pompa inhibitörlerini içeren konservatif takip de düşünülebilir.
Gastroduodenal perforations are critical emergency conditions that mostly develop as a complication of peptic ulcer disease, serving as a major cause of surgical peritonitis. Patients typically present with a sudden, sharp, and severe abdominal pain, and physical examination often reveals a rigid "board-like" abdomen. For diagnosis, erect chest X-rays are highly valuable, showing an 86% sensitivity for free air under the diaphragm, whereas computed tomography stands as the most reliable diagnostic method. The primary treatment approach is surgical, where the Graham omental patch technique remains the standard method in both open and laparoscopic surgeries. Alternatively, in highly selected cases where the perforation is confirmed to be sealed, non-operative conservative management may be considered.
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