İnflamatuar Bağırsak Hastalığında Acil Cerrahi Tedavi
Özet
İnflamatuar bağırsak hastalığı (İBH), Crohn Hastalığı (CH) ve Ülseratif Kolit’i (ÜK) kapsayan kronik bir süreçtir. Son yıllarda tıbbi tedavi yöntemlerindeki ve multidisipliner yaklaşımlardaki ilerlemeler sayesinde hastaneye yatış ve elektif cerrahi oranlarında belirgin bir azalma gözlense de, acil cerrahi müdahale gerektiren komplike olgular halen önemli bir klinik sorun teşkil etmektedir. Hastalar acil servislere sıklıkla hastalık alevlenmeleri, toksik kolit, toksik megakolon, masif kanama, perforasyon, abse, fistül veya intestinal obstrüksiyon gibi hayatı tehdit eden komplikasyonlarla başvurmaktadır. Acil değerlendirmede ilk adım; sıvı-elektrolit bozukluklarının ve malnütrisyonun düzeltilmesi, ampirik antibiyoterapi ile venöz tromboemboli profilaksisinin başlanmasıdır. Tanı ve tedavi stratejisinin belirlenmesinde, perforasyon, abse ve obstrüksiyon gibi komplikasyonları en optimal şekilde ortaya koyan İV kontrastlı bilgisayarlı tomografi (BT) en faydalı görüntüleme yöntemi olarak öne çıkmaktadır. Akut ağır kolit ve toksik megakolon durumlarında öncelikle agresif medikal tedavi denenmeli, ancak yanıt alınamayan, perforasyon veya masif kanama gelişen hastalarda acil cerrahi kaçınılmaz olmaktadır. Hem ÜK hem de CH ilişkili akut ağır kolit ile toksik megakolonda tercih edilen standart acil cerrahi prosedür total/subtotal abdominal kolektomi ve uç ileostomidir. Sonuç olarak, komplike İBH yönetiminde erken ve doğru değerlendirme ile multidisipliner yaklaşım esastır.
Inflammatory bowel disease (IBD) encompasses Crohn's Disease (CD) and Ulcerative Colitis (UC), both characterized by chronic inflammation. Although advancements in medical treatments and multidisciplinary approaches have recently decreased hospitalization and elective surgery rates, complicated cases requiring emergency surgical intervention remain a significant clinical challenge. Patients frequently present to emergency departments with life-threatening complications such as acute severe exacerbations, toxic colitis, toxic megacolon, massive hemorrhage, free perforation, abscesses, fistulas, or intestinal obstruction. The initial emergency management focus on correcting fluid-electrolyte imbalances, addressing malnutrition, and initiating empirical antibiotic therapy along with venous thromboembolism prophylaxis. For diagnostic evaluation, IV contrast-enhanced computed tomography (CT) stands out as the most definitive modality to identify complications like perforations, abscesses, or obstructions. In cases of acute severe colitis and toxic megacolon, aggressive medical therapy is initially recommended; however, emergency surgery becomes mandatory for patients who fail to respond or develop perforation and massive bleeding. Total or subtotal abdominal colectomy combined with an end ileostomy is the gold standard emergency surgical procedure preferred for both UC and CD under these critical conditions. Ultimately, early accurate evaluation and a multidisciplinary approach are crucial for safe management.
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