Ulus Travma Acil Cerrahi Derg. 2024; 30(4): 305-308 | DOI: 10.14744/tjtes.2024.20813

Ateþli silah yaralanmasý ve Deloyers prosedürü: vaka raporu ve literatür derlemesi

Cengiz Ceylan
Ýnönü Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Malatya, Türkiye

Geniþ kolon rezeksiyonlarý sonrasýnda kolorektal anastomoz yapmak mümkün olmayabilir. Bu nedenle, sað kolon transpozisyonu ile yapýlan Deloyers prosedürü tanýmlanmýþtýr. 2010-2023 yýllarý arasýnda yapýlan Deloyers prosedürlerini inceleyerek, prosedürün hangi durumlarda uygulandýðýný ve erken ile geç dönem sonuçlarýný tartýþmayý amaçladýk. Ateþli silah yaralanmasý sonucu sigmoid kolon, inen kolon, transvers kolon ve mezenterde büyük organ ve doku kaybý yaþayan 22 yaþýndaki bir kadýn hastada, hasar kontrol cerrahisini takiben restoratif cerrahide Deloyers prosedürü uygulandý. Çekum ve sað kolonun mobilizasyonu sonrasýnda, ileokolik arter pedikülü üzerinde kraniokaudal yönde rotasyon yapýldý, ardýndan appendektomi gerçekleþtirildi. Kolorektal anastomoz ise sirküler stapler ile oluþturuldu. Postoperatif takiplerde herhangi bir komplikasyon geliþmedi. Postoperatif 14. günde hasta taburcu edilen hastanýn barsak hareketleri 2.5 mg difenoksilat hidroklorür ve 0.025 mg atropin sülfat tedavisi ile günde 4 kezdi. 6 aylýk izlemde, medikal tedaviye ihtiyaç duymaksýzýn barsak hareketleri günde 2'ye düþtü. Geniþ sol kolektomileri takiben hastalarýn fonksiyonel sonuçlarýný düþünerek, düþük morbiditesi olan Deloyers prosedürü güvenle uygulanabilir.

Anahtar Kelimeler: Ateþli silah yaralanmasý, deloyers prosedürü; sað kolon transpozisyonu; sað kolon-rektal anastomoz.

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Firearm injury and the Deloyers procedure: case report and literature review

Cengiz Ceylan
Department of Surgery, Inönü University, Malatya-Türkiye

Following extended colon resections, it may not always be possible to perform colorectal anastomosis. The Deloyers procedure, which involves the transposition of the right colon, has been identified as a viable solution. This report aims to discuss the circumstances under which the Deloyers procedure was performed, as well as to evaluate the early and late postoperative outcomes, by reviewing cases conducted between 2010 and 2023. In a 22-year-old female patient who suffered major organ and tissue loss (with injuries to the sigmoid colon, descending colon, transverse colon, and mesentery) due to a firearm injury, the Deloyers procedure was applied during restorative surgery following initial damage control surgery. The procedure involved mobilizing the cecum and right colon, performing a cranio-caudal rotation over the ileocolic artery pedicle, followed by an appendectomy, and creating a colorectal anastomosis using circular staplers. There were no complications during the postoperative follow-ups. By the 14th postoperative day, the patient was discharged and experienced bowel movements four times a day, managed with 2.5 mg of diphenoxylate hydrochloride and 0.025 mg of atropine sulfate. At the 6-month follow-up, the frequency of bowel movements had decreased to twice daily without the need for medical treatment. Given the functional outcomes in patients after extended left colectomies, the Deloyers procedure, with its low associated morbidity, stands out as a viable option.

Keywords: Deloyers procedure, firearm injury; right colon transposition; right colon to rectal anastomosis.

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