Çocuklarda Ameliyat Sonrası Yapışıklıklara Bağlı Barsak Tıkanıklıkları Tedavisinde Konservatif Yaklaşımın Yeri

Abstract

Intestinal obstructions due to postoperative adhesions are among important surgical problems that may cause morbidity and even mortality during childhood. The treatment of intestinal obstructions due to postoperative adhesions are controversial. Immediate operation following the diagnosis, or conservative approach unless there is no doubt about the development of vascular compromise in the intestine or intestinal perforation. Children who undergone treatment following the diagnosis of small bowel obstruction due to postoperative adhesions during a 10-year period in Hacettepe Children’ s Hospital Department of Pediatric Surgery were evaluated to determine the results and complications of conservative approach. Our study group consisted 70 children. While 59 (%84) children were treated by conservative approach, 11 (%16) children have necessitated surgical approach. Successful conservative treatment required less than a five-day period. The decisions for operatins were established following a period of conservative approach which has been longer than 5 days. Two children among 11 required intestinal resection because of vascular compromise of the intestine, and a child required intestinal resection because of iatrogenic injury. Because the dense adhesions could not be relieved, an enterostomy proksimal to the adeshions was performed in a child. Conservative approach can be safely utilised in children admitting with intestinal obstructions due to postoperative adhesions. However, any sign of vascular compromise of intestine, or persistence of obstruction following a-five-day conservative treatment period should prompt the surgical treatment.