Ulus Travma Acil Cerrahi Derg. 2019; 25(6): 585-588 | DOI: 10.14744/tjtes.2019.31967

Peptik ülser perforasyonunun ameliyatsýz tedavisi: Tek merkez deneyimi

Koray Karabulut¹, Mürþit Dinçer², Rumeysa Kevser Liman², Sertaç Usta^3
1Memorial Þiþli Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Fýrat Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Elazýð
³Ýnönü Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Malatya

AMAÇ: Perforasyon, peptik ülserin nadir bir komplikasyonudur. Peptik ülser perforasyonunun yaygýn kabul gören tedavisi cerrahi olmakla birlikte, ameliyatsýz tedavi seçilmiþ hastalarda bir seçenek olabilir. Bu çalýþmada, peptik ülser perforasyonunda ameliyatsýz tedavi tecrübemizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2012 ile Eylül 2017 tarihleri arasýnda peptik ülser perforasyonu tanýsýyla kliniðimizde tedavi edilen hastalara ait veriler geriye dönük olarak deðerlendirildi. Taný, fizik muayene ve radyoloji bulgularý ile kondu. Ameliyatsýz tedavi, vital parametreleri normal olup, fizik muayenede yaygýn peritonit bulgularý olmayan seçilmiþ hastalara aydýnlatýlmýþ onamdan sonra uygulandý. Hastalarýn tamamýnda aðýzdan gýda ve sývý alýmý durduruldu, intravenöz sývý, antibiyotik ve pantoprazol baþlandý.
BULGULAR: Çalýþma süresince 41 hasta kliniðimize peptik ülser perforasyonu tanýsý ile yatýrýlarak tedavi edildi. Bu hastalarýn 35’i ameliyat edilirken altýsý konservatif olarak takip edildi. Hastalarýn tamamýnda, fizik muayenede karýn üst kadranlarda periton irritasyon semptom ve bulgularý vardý. Hiçbirinde yaygýn peritonit mevcut deðildi. Hastalarýn tamamýna direkt karýn grafisi ve tomografi çekildi. Ameliyatsýz tedavi grubundaki hastalarýn hiçbirine takip süresince cerrahi veya giriþimsel radyolojik bir iþlem yapma gerekliliði oluþmadý. Bu gruptaki hastalarda ortanca hastanede kalýþ süresi dört gündü. Hastalarýn tamamý sorunsuz olarak taburcu edildi.
TARTIÞMA: Peptik ülser perforasyonlu hastalarýn çoðunda standart tedavi halen cerrahidir. Ameliyatsýz tedavi, vital parametreleri normal olan ve karýn muayenesinde yaygýn peritonit bulgularý olmayan seçilmiþ hastalarda bir tedavi seçeceði olarak akýlda bulundurulmalýdýr. Bu þekilde, gereksiz yere cerrahi yapmaktan ve cerrahinin olasý morbidite ve mortalitesinden kaçýnmak mümkün olabilir.

Anahtar Kelimeler: Ameliyatsýz tedavi, konservatif tedavi; peptik ülser perforasyonu.

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Non-operative management of perforated peptic ulcer: A single-center experience

Koray Karabulut¹, Mürþit Dinçer², Rumeysa Kevser Liman², Sertaç Usta^3
1Department of General Surgery, Memorial Sisli Hospital, Ýstanbul-Turkey
²Department of General Surgery, Fýrat University Faculty of Medicine, Elazýð-Turkey
³Department of General Surgery, Ýnönü University Faculty of Medicine, Malatya-Turkey

BACKGROUND: Perforation is a rare complication of peptic ulcer. Although the most widely accepted treatment for peptic ulcer perforation is surgery, non-operative treatment can be an option in selected patients. In this study, we aimed to present our non-surgical treatment experience in peptic ulcer perforation.
METHODS: In this study, the data of the patients who were treated due to peptic ulcer perforation between January 2012 and September 2017 in our clinic were retrospectively reviewed. The diagnosis was reached by physical examination and radiologic findings. After obtaining the informed consent from the patients, non-operative treatment was performed to the selected patients who had normal vital parameters and did not have findings of generalized peritonitis in the abdominal examination. Oral food and fluid intake were stopped and intravenous fluid, antibiotics and pantoprazole were administered to all patients in this study.
RESULTS: A total of 41 patients were treated due to the diagnosis of peptic ulcer perforation in our clinic during the study period. Out of 41 patients, while 35 of the patients were operated, six of them were treated non-operatively. There were peritoneal irritation signs and symptoms in the upper quadrants on physical examination in all of the patients. None of them had generalized peritonitis. Abdominal X-ray and computed tomography were obtained from all of the patients. None of the patients in the non-operative group underwent any interventional procedure or surgery during the follow-up period. The median length of hospital stay was four days in this group. All of the patients were discharged uneventfully.
CONCLUSION: Standard treatment of peptic ulcer perforation in most of the patients is still surgical repair. Non-surgical treatment should be kept in mind as an option in the selected patients who had normal vital parameters and did not have any findings of generalized peritonitis in the abdominal examination. In this way, it may be possible to avoid unnecessary surgery and reduce the possible morbidity and mortality associated with the operation.

Keywords: Conservative treatment, non-operative treatment, peptic ulcer perforation.

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