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- Karın Apsesi Neden Olur, Nasıl Geçer? Prof. Dr. Turgut İPEK
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: Karın Apsesi Neden Olur, Nasıl Geçer? Prof. Dr. Turgut İPEK
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Karın boşluğu içerisinde gelişen apseler intra-abdominal apse olarak adlandırılır.
İntra–abdominal apseler ya periton içerisinde (intraperitoneal) ya da periton dışarısında (retroperitoneal) gelişebilirler.
İNTRAPERİTONEAL APSELER
İntra-abdominal apse etiyolojisinde çok sayıda sebep olsa da en sık intra-abdominal apse nedenleri aşağıda görülmektedir.
A- Gastrointestinal sistem patolojileri
İçi boş organ perforasyonları (peptik ülser, ince ve kalın barsak perforasyonları)
Vasküler tıkanmalar (mezenterik arter tıkanmaları)
B- Postoperatif komplikasyonlar
Anastomoz kaçakları, unutulmuş safra taşları
C- Penetran ve künt karın travmaları
Karın içi organ yaralanmaları
D- Genito-üriner enfeksiyonlar
APSE YERLEŞİMLERİ
Subfrenik, parakolik, sağ alt kadran ve pelvik apseler en sık görülen intra-abdominal apse yerleşimleridir (Şekil 2).
Tablo 1: Apse yerleşimleri ve sebepleri
Israr eden karın ağrısı, lokal hassasiyet, bacaklı ateş, uzamış ileus, lökositoz ve aralıklı polimikrobial bakteriyemi bulguları, intra-abdominal apseyi akla getirmelidir.
Enfeksiyonu düşündüren hematolojik parametreler (lökositoz, anemi, anormal trombosit sayısı, anormal karaciğer fonksiyonları) sıklıkla mevcuttur.
Tanı
Düz karın filmi Ultrasonografi (US) Bilgisayarlı tomografi (BT) Manyetik Rezonans görüntüleme (MRI) Sintigrafi US veya BT ile püy aspirasyonu TEDAVİ
Apsenin tümüyle drenajı, primer sebebin tedavi edilmesi ve ilave antibiyotiklerin kullanılmasından ibarettir.
Medikal tedavi: Antibiyotik tedavisi söz konusudur.
Cerrahi tedavi: İntra-abdominal apselerin kesin tedavisi apsenin drene edilmesidir.
Perkütan apse drenajı: Non operatif bir yöntem olup intra-abdominal apselerin çoğununun tedavisinde tercih edilmektedir. BT rehberliğinde perkütan kateter drenajı günümüzde standard tedaviyi oluşturur.
Açık apse drenajı: Perkütan drenajın başarısız veya uygunsuz olduğu intra-abdominal apselerde tedavi açık drenajdır.
Laparoskopik apse drenajı: İntra-abdominal apselerin drenajında açık yöntemin alternatifi olarak uygulanabilir.
RETROPERİTONEAL APSELER
Diafragmadan pelvise kadar uzanan geniş bir alan olan retroperitoneal boşluk ön ve arka bölümlere ayrılır. Ön bölümde pankreas, duodenum, çıkan ve inen kolon, arka bölümde ise adrenal, böbrekler ve perinefritik alan yer alır. İntraperitoneal apselere göre daha az görülürler.