OUR EXPERIENCE OF EMBOLECTOMY AT ACUTE MESENTERIC ISCHEMIA

Between January 1992 and September 1998, 74 patients were operated with the diagnosis of mesenteric vascular occlusion. Superior mesenteric artery exploration were performed in 9 of these patients since necrosis of the bowel were not established completely. In two patients the ischemia on the effected segments of the bowel were completely perfused and resection was not necessary (22.2%). In two patients part of the ischemic area could be reperfused and limited resection was performed (22.2%). In five patients embolectomia was unsuccessful (55.6%). Six patients (66.6%) developed sepsis. Three patients died (33.4%). In patients with severe abdominal pain and in whom acute mesenteric vasculary occlusive disease risk is high if angiography can not be performed, laparotomy must be done immediately and in patients in the ischemic period superior mesenteric artery must be explored and if the thrombus is detected, embolectomy must be performed. The possibility of sepsis should also be kept in mind due to the translocation of bacteria and free radicals after the reperfusion.

AKUT MEZENTER ÝSKEMÝDE EMBOLEKTOMÝ TECRÜBEMÝZ

Ocak 1992 ile Eylül 1998 tarihleri arasýnda mezenterik vasküler oklüziv hastalýk tanýsý ile ameliyat edilen 74 olgunun dokuzunda barsak nekrozunun tam olarak yerleþmemesi nedeniyle superior mezenter arter (SMA) eksplorasyonu uygulanarak sorunun emboli olduðu olgularda embolektomi yapýldý. Dokuz olgunun 2'sinde barsaktaki iskemi tamamen düzeldi ve rezeksiyon gerekmedi (%22.2). Ýki olguda ise iskemik bölgenin bir bölümünde reperfüzyon saðlandý ve masif barsak rezeksiyonu gerekmedi (%22.2). Kalan 5 olgu ise embolektomiden yarar görmedi (%55.6). Altý olguda sepsis geliþti (%66.6), üç olgu ise kaybedildi (%33.4). Fizik muayene ve laboratuvar bulgularý desteklemese bile, akut mezenter oklüziv hastalýk olabilme riski yüksek, þiddetli karýn aðrýsý olan olgularda anjiografi olanaðý yoksa laparotomiden kaçýnýlmamasý, barsakta nekroz yerleþmemiþ ise SMA'in ekplore edilmesi ve sorun emboli ise embolektomi yapýlmasý gerektiði kanýsýndayýz. Reperfüzyondan sonra serbest oksijen radikallerine baðlý reperfüzyon hasarý ve bakteriyel translokasyona baðlý sepsis olasýlýðýnýn da göz ardý edilmemesi gerektiði görüþündeyiz.