Çocuklarda duodenum perforasyonlarý

Amaç: Kliniðimizde duodenal perforasyon nedeniyle takip ve tedavisi yapýlan olgularýn incelenmesidir.
Olgular ve Yöntem: Duodenal perforasyon tanýsý ile 1990 – 2014 yýllarý arasýnda tedavi edilen 14 olgunun kayýtlarý geriye dönük olarak incelendi.
Bulgular: 1990 – 2014 yýllarý arasýnda kliniðimize baþvuran 14 olgunun (8E, 6K) ort. baþvuru yaþý 6,2 yýl (25 gün - 16 yýl)dý. Ýki olgu primer olarak baþvuruda bulunurken, 12 olgu dýþ merkezlerden yönlendirilmiþti. Ortalama baþvuru süresi 3,2 (1 gün – 1 hafta) gündü. Perforasyon nedeni 10 olguda duodenal ülser, 3 olguda travmatik perforasyon, ichtiosisli 2 aylýk bir olguda ise idiopatik idi. Bir olguda nesidioblastozis nedeniyle totale yakýn pankreatektomi sonrasýnda hiperbilüribineminin devam etmesi üzerine yapýlan laparotomide duodenal perforasyon saptanarak hastaya duodenum 1. ve 2. kýtalara rezeksiyon, pilor rezeksiyonu, koledekojejunostomi, gastrojejunostomi ve jejunojejunostomi uygulandý. Kalan 13 hastada primer tamir yapýldý. Primer tamir yapýlan hastalarýn birinde ek olarak gastrostomi açýlýrken 9 olguya omentoplasti yapýldý. Takipte 12 olgunun herhangi bir klinik yakýnmasý yokken, iki olgu kaybedilmiþtir.
Sonuç: Duodenal perforasyonlar çocuk cerrahlarýnýn nadir karþýlaþtýklarý cerrahi problemlerden biridir. Bu nedenle karýn aðrýsýnýn ayýrýcý tanýsýnda akýlda tutulmalýdýr. Cerrahi saðaltýmda primer onarým (duodenorafi ± omentoplasti), etkin ve güvenli bir cerrahi yöntemdir.

Duodenum perforations in children

Aim: To analyse patients those admitted to our clinic due to perforation in duodenum. Patients and Method: Fourteen patients those have been admitted to our center with perforation in duodenum between 1990 – 2014 analysed retrospectively. Results: Ten patients (8M, 6F) those have been admitted to our clinic between 1990 – 2014 have a mean age of 6.2 years (25 days – 16 years). Two of cases admitted directly to our clinic and the rest refered from another hospitals. Mean time for appliance to our clinic was 3.2 days ( 1day – 1 week). Ulcer in duodenum was the cause of perforation in 10 cases while in 3 the cause was trauma and in 1 case was surgical complication of infantyl persistant hyperinsulinism (IPHH). The case with hyperbilluribinemia after near total pancreatectomy due to IPHH had been explored and perforation in deuedenum diagnosed. Resection in first two parts of duodenum and pylor, choledochojejunostomy, gastrojejunostomy and jejunojejunostomy was performed. Primary repair was performed in the remaining patients. In one case with primary repair gastrostomy was performed, while in 9 cases omentoplasty were performed. In the follow-up 12 cases has no problems and doing well. Two patients died.
Conclusion: Perforation in duedenum is a rare entity that pediatric surgeons should encounter and keep in mind. Primary repair(duodenoraphy ± omentoplasty) is safe and reliable surgical treatment modality.