Sezaryen Sonrası İntraabdominal Apse Oluşumu Tanı ve Tedavi Yaklaşımları
Özet
Sezaryen doğum oranları dünya çapında artmakta ve bu cerrahi sonrasında intraabdominal apse gibi ciddi enfeksiyöz komplikasyonlar gelişebilmektedir. Genellikle ameliyat sonrası 8 ila 10. günlerde ateş, alt karın ağrısı, bulantı ve vajinal akıntı gibi semptomlarla ortaya çıkan bu apselerin tanısında, ultrasonografiye göre daha yüksek doğruluk oranına sahip olan Bilgisayarlı Tomografi (BT) öncelikli olarak tercih edilmektedir. Klinik yaklaşımda, tedavi edilmeyen vakalarda mortalite oranının %80-100'e ulaşabilmesi nedeniyle erken tanı kritik öneme sahiptir. Tedavide, 3 cm'den küçük apseler için tek başına geniş spektrumlu intravenöz antibiyotik kombinasyonları (klindamisin/metronidazol ile penisilin/ampisilin ve gentamisin) önerilirken, kapsüllü ve daha büyük lezyonlarda görüntüleme eşliğinde perkütan cerrahi drenaj ilk seçenek olarak uygulanmaktadır. Perkütan drenaj, genel anestezi gerektirmemesi, düşük komplikasyon riski ve %90'ın üzerindeki başarı oranıyla standart tedavi yöntemi haline gelmiştir. Ancak, yaygın peritonit ve multipl organ yetmezliği bulguları gösteren akut vakalarda, mortaliteyi azaltmak adına vakit kaybetmeden cerrahi girişim (relaparotomi) planlanmalıdır. Tedavi edilmeyen pelvik apseler sekonder infertilite, ektopik gebelik ve kronik pelvik ağrı gibi kalıcı sekellere yol açabileceğinden, tüm riskler hasta ile ayrıntılı olarak paylaşılmalıdır.
Caesarean section rates are increasing globally, and serious infectious complications such as intra-abdominal abscesses can develop following this surgery. These abscesses typically manifest around the 8th to 10th postoperative days with symptoms including fever, lower abdominal pain, nausea, and vaginal discharge, and Computed Tomography (CT) is preferentially utilized for diagnosis due to its higher accuracy compared to ultrasonography. In clinical practice, early diagnosis is critical because the mortality rate can reach 80-100% in untreated cases. Regarding treatment, broad-spectrum intravenous antibiotic combinations (clindamycin/metronidazole plus penicillin/ampicillin and gentamicin) are recommended alone for abscesses smaller than 3 cm, whereas imaging-guided percutaneous surgical drainage is implemented as the primary choice for encapsulated and larger lesions. Percutaneous drainage has become the standard treatment modality owing to its lack of requirement for general anesthesia, low risk of complications, and success rates exceeding 90%. However, in acute cases presenting signs of generalized peritonitis and multiple organ failure, prompt surgical intervention (relaparotomy) must be planned without delay to reduce mortality. Since untreated pelvic abscesses can lead to permanent sequelae such as secondary infertility, ectopic pregnancy, and chronic pelvic pain, all risks must be discussed in detail with the patient.
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