Buradasınız

DUODENAL DİVERTİKÜLOSİS OLGULARINDA KLİNİK ANALİZ VE LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (Original Language): 
İlerleyen yaş ile daha sıklıkla karşılaşılırsa da duodenal divertikülozis nadir bir klinik antitedir. Üst Gastrointestinal muayenelerde rastlantısal olarak keşfedilen duodenal divertiküller ekseriyetle asemptomatiktir, ancak önemli morbidite kaynağı olabilir. Duodenal divertikül majör duodenal papillanın yakınına yerleşmişse juxtapapiller (periampuller) duodenal divertikül olarak isimlendirilirler. Bu çalışmanın hedefi duodenal divertiküllü hastalarda klinik karakteristikler sıklık klinik bulgular ve tedavi çeşitlemelerini araştırmaktır. Biz 1983-2003 arasında kliniğimizde cerrahi tedavi geçirmiş duodenal divertikül olgularının retrospektif olarak gözden geçirdik. Klinik bulgular ve patolojik sonuçları olguların kayıtlarından öğrenilmiştir. 1983’ten 2003 kadar duodenal divertiküllü 25 hasta kliniğimizde tedavi edildi. Onların yaşları 43-80 yaşları arasında değişiyordu. Ortalama yaşları 58,1 idi. Olguların 15’i kadın (%60) 10’nu erkek idi (%40). Duodenum 2. bölümünde divertiküller 15 (% 60) olguda tespit edildi Duodenum 3. bölümünde divertiküller 6 olguda (%24) ve 4. bölümünde 4 olguda (%16) tespit edildi. Multipl divertiküller sadece 2 olguda bulundu. 9 olguda nüks kolanjit atakları ilerleyici sarılık batın ağrısını kapsayan bilio-pankreatik semptomlar vardı. 3. ve 4. bölümlerin divertiküllü hastalarında batın ağrısı ve kusma ana semptomlardır. Divertikülektomi etkili bir cerrahi işlemdir. Juxtapapiller duodenal divertiküller bilier taş oluş masında önemli sebep olucu faktörlerdir. Gastrointestinal kanalda, divertikül hastalığının kolon’dan sonra ikinci en sık yerleşim yeri duodenum’dur. Hastalığın klinik olarak önemi, sadece akademik olarak ilginç oluşundan, hastaların hayatını tehdit eden komplikasyonlara kadar değişir. Kolon dışında nadir olması sebebiyle, ekseriya hastaların şikayetlerinin bir duodenal divertikül (DD) kaynaklı olduğu düşünülmeyebilir. Bu da teşhiste gecikmeye yol açar.1,2 Bu retrospektif çalışmada kliniğimizde DD sebebiyle cerrahi tedavi görmüş hastalar irdelenmiştir.
120-127

REFERENCES

References: 

1. Brian JE, Stair JM. Noncolonic Diverticular Disease,
Surg. Gynecol Obstetr, 1985; 161: 189-94.
2. Umbricht – Sprunali R, Hollinger A, Meier L, Largiader
F. Die komplikationen von Divertikeln in Oberen
Bündarm, Chirurg: 1992; 63: 568-71.
3. Gross SA, Katz S. Small Bowel Diverticulosis: An
Overlooked Entity. Curr Treat Options Gastroenterol
2003; 6: 3-10.
4. Kouraklis G, et al. Diverticular Disease of the Small
Bowel: Report of 27 Cases. Int Surg. 2001; 86: 235-401.
5. Whang EE, Ashley SW, Zinner MJ. In Small Intestine;
Brunicardi FC, Anderson DK, Billiar TR. Dunn DL
Hunter JG, Pollock RE (Eds); Schwart’s Principles of
Surgery; 8th Ed. Mc Graw-Hill Medical Publishing
Division; 2005; 1017-54.
6. Lapin R, Kamath ML, Engler J, Friedman H. Massive
Gastrointestinal Hemorrhage from a Duodenal
Diverticulum, Am.J Gastroenterol 1974; 610: 185-90.
7. Tocchi A, Basso L, Gosta G, Lepre L, Liotta G, Mazzom
G. Surgical Treatment of Duodenal Diverticula Acta Chir
Belg. 1993; 93: 145-146.
8. Afridi SA, Fichtenbaum CJ, Taubin H. Review of
Duodenal Diverticula Am J Gastroenterol 1991; 86: 935-
38.
9. Osnes M, Lotveit T, Larsen S, Aune S. Duodenal
Diverticula and Their Relation to Age Sex and Biliary
Calculi Scand J Gastroenterol 1981; 16: 103-112.
10. Lobo DN, Balfour TW, Iftikhar SY. Periampullary
Diverticula and Pancreaticabiliary Disease Br J. Surg:
1999; 86: 588-593.
11. Pinatti HW, Tacla M, Conte VP, Bettavello A.
Diverticulos Duodenais Juxta-Ampulares Arg
Gastroenter 1966; 3: 209-215.
12. Leivonen MK, Halttunen JA, Kivilaakso EO. Duodenal
Diverticulum at Endoscopic Retrograde
Cholangiopancreato-Graphy; Analysis of 123 patients
Hepatogastroenterology; 1996; 43; 961-66.
13. Yin WY, Chen HT, Huang SM, Lin HH, Chang TM.
Clinical Analysis and Literature Review of Massive
Duodenal Diverticular Bleeding World J Surg 2001; 25:
848-55.
14. Hendelsman JC, Murphy G, Fishbein K. Duodenal
Diverticulum; Clinical Significance and Surgical
Treatment. Am J Surg 1960; 26: 272-77.
15. Jones TW, Merendino KA. The Perplexing Duodenal
Diverticulum Surgery; 1960; 481068-84.
16. Zoepf T, .Zoepf DS, Arnold JC, Benz C, Riemann JC.
The Relationship between Juxtapapillary Duodenal
Diverticula and Disorders of the Biliopancreatic System:
Analysis of 350 Patients Gastrointest Endosc 2001; 54:
56-61.
17. Finnie IA, Ghosh P, Garvey C, .Poston GJ, Rhodes JM.
Intraluminal Duodenal Diverticulum Causing Recurrent
Pancreatitis; Treatment by Endoscopy Gut: 1994; 35:
557-59.
18. Ketsel W, Fischbach W, Wilhelm A. Rare Cause of
Acute Pancreatitis: Phytobezoar in an İntraluminal
Diverticulum in Type-I Duodenal Atresia, İntestinal
Malrotation and Rudimentary Pancreas Anulare Z.
Gastroenterol 1998; 36: 295-9.
19. Massucco P, Sabbatina F, Fornarı M. Surgical Treatment
of İnternal Duodenal Diverticulum: Report of 2 Clinical
Cases Minerva Chir 1999; 54: 813-17.
20. Tsukamato T, Ohta Y, Hamba H, Sasaki Y, Tokuhara T,
Kubo S, Hirohashi K, Kinoshita H. Perforated Duodenal
Diverticulum: Report of two Cases
Hepatogastroenterology; 1999; 46: 1755-58.
21. Franzen D, Gurtler T, Metzger U. Solitary Duodenal
Diverticulum with Enterolith as a Rare Cause of Acute
Abdomen Swiss Surg 2002; 8: 277-9.
22. Sakurai Y, Miura H, Matsubara T, Imazu H, Hasegawa S,
Ochiai M. Perforated Duodenal Diverticulum
successfully Diagnosed Preoperatively with Abdominal
CT scan Associated with Upper Gastrointestinal Series J
Gastroenterol 2004; 39: 379-83.
23. Yokomuro S, Uchida E, Arima Y, Mizuguchi Y, Shimizu
T, Kawahigashi Y, Kawamoto M, Takahashi K, Arai M,
Arima Y, Tajiri T. Simple Closure of a Perforated
Duodenal Diverticulum: “a Case Report” J Nippon Med
Sch 2004; 71: 337-9.
24. Cavanagh JE Jr. Iatrogenic Perforation of Perivaterion
Duodenal Diverticulum: Report of a Case Can J Surg
1996; 39: 336-8.
25. Juler GL, List JW, Stemmer EA, Connoly JE. Perforated
Duodenal Diverticulitis Arch Surg 1969; 99: 572-8.
26. Duarte B, Nagy KK, Cintron J. Perforated Duodenal
Diverticulum Br J Surg 1992; 79; 877-81.
27. Vanek VW, Mc Namara K, Lyras LS. Perforated
Duodenal Diverticulum: Case Report and Literature
Review Contemp Surg; 1989; 34: 36-47.
28. Atmani A, Lachachi F, Sodji M, Darand-Fontanier S,
Moumovni I, Pech De La Clause B, Valleix D, Des
Eottes B. Perforated Juxta-Papillary Duodenal
Diverticula: Two Cases Gastroenterol Clin Biol 26; 285-
8.
29. Patterson RH, Bromberg B. Surgical Significance of
Duodenal Diverticula Ann Surg. 1951; 134: 834-40.
Temmuz-Eylül 2005 DUODENAL DİVERTİKÜL; ERSAN VE ARK.
127
30. Rowlands BC, King PA. Duodenal Diverticulum
Perforating into Abdominal Aorta Causing Fatal
Hemorrgage Br J Surg 1954; 41: 415-20.
31. Coelho JC, Sousa GS, Salvalaggio PR. Laparoscopic
Treatment of Duodenal Diverticulum Surg Laporose
Endosc 1999; 9: 74-7.
32. Tagaya N, Shimoda M, Hamada K, Ishikawa K, Kogure
H. Laparoscopic Duodenal Diverticulectomy Surg
Endosc 2000; 14: 592-599.
33. Ryan ME, Hamilton JW, Morrissey JF. Gastrointestinal
Hemorrhage from a Duodenal Diverticulum Gastrointest
Endosc 1984; 30: 84-92.
34. Bradham GB, Martin JB. Massive Bleeding from a Polyp
in a Duodenal Diverticulum Ann Surg 1962; 156: 81-8.
35. Gunsar F, Yıldız C, Aydın A, Ozutemiz OA.
Angiodysplasia in a Duodenal Diverticulu as an Unusual
Cause of Upper GastrointestinalBleeding Eur J
Gastroenterol Hepatol 2001; 13: 717-19.
36. Mahajan SK, Vaidya P, Sood BR, Gupta D, Sharma A.
Duodenal Diverticular Hemorrhage in a Patient Taking
NSAID J Assoc Physicians India 2003; 51: 416-8.
37. Pises P. Bleeding Duodenal Diverticulum Am J
Gastroenterol: 1965; 43: 121-26.
38. Callery MP, Aliperti G, Soper NJ. Laparoscopic
Duodenal Diverticulectomy Following Hemorrhage Surg
Laparosc Endosc 1994; 4: 134-8.
39. Avit-Miossec S, Alves A, Vahedi K, Paris Y, Laisne MJ,
Richet F, Valleur P. Diagnostic and Therapeutic Strategy
in Duodenal Diverticular Bleeding: Report of two Cases
and Review of Literature Ann Chir 2004; 129: 170-3.
40. Hamada N, Ishizaki N, Shirahama K, Nakamura N,
Murata R, Kadono J, Shimazaki T, Sameshima T, Misono
T, Taira A. Multiple Duodeno-Jejunal Diverticula
Causing Massive İntestinal Bleeding J Gastroenterol
2000; 35: 159-62.
41. Gunji N, Miyamoto H. Endoscopic Management of
Upper Gastrointestinal Bleeding from a Duodenal.
Diverticulum Hepatogastroenterology 2004; 50: 1940-42.
42. Novacek G, Walgram M, Bauer P, Schofl R, Gondl A,
Potzi R. The Relationship between Juxtapapillary
Duodenal Diverticula and Biliary Stone Disease Eur J.
Gastroenterol Hepatol 1997; 9: 375-9.
43. De Koster E, Denis P, Monte M, Otero J, Nyst J, Jonas C,
Van Gossum M, De Reuck M, Deltenre M. Juxtapapillary
Duodenal Diverticula: Association with Biliary Stone
Disease Acta Gastroenterol Belg. 1990; 53: 338-43.
44. Rajnakova A, Goh PM, Ngoi SS, Lim SG. ERCP in
Patients with Periampullary Diverticulum.
Hepatogastroenterology; 2003; 50: 625-8.
45. Uoma G, Manes G, Ragozzino A, Cavallera A, Rapitti
PG. Periampullary Extraluminal Duodenal Diverticula
and Acute Pancreatitis: An underestimated Etiological
Association Am J Gastroenterol 1996; 91: 1186-8.
46. Tham TC, Kelly M. Association of Periampullary
Duodenal Diverticula with Bile Duct Stones and with
Technical Success of Endoscopic Retrograde
Cholangiopancreatography Endoscopy; 2004; 36: 1050-3.
47. Christoforidis E, Goulimaris I, Kanellos I, Tsalis K,
Dadoukis I. The Role of Juxtapapillary Duodenal
Diverticula in Biliary Stone Disease Gastrointest Endosc.
2002; 55: 543-7.
48. Kim MH, Myung SJ, Seo DW, Lee SK, Kim YS, Lee
MH, Yoo BM. Association of Periampullary Diverticula
with Primary Choledochilithiasis, but not with Secondry
Choledocholithiasis Endoscopy; 1998; 30: 601-4.
49. Lotveit T, Osnes M. Duodenal Diverticula Scand J
Gastroenterol 1980; 19: 579-81.
50. Sugiyama M, Atomi Y. Periampullary Diverticula Cause
Pancreaticobiliary Reflux Scand J Gastroenterol 2001;
36: 994-7.
51. Van Nieuwkoop C, Boere I, Rosekrans PA, Bac DJ.
Recurrent Bacterial Cholanaitis due to a Juxtapapillary
Diverticulum Eur J Gastroenterol Hepatol 2002; 14: 189-
90.
52. Castilho Netto JM, Speranzini MB. Ampullary Duodenal
Diverticulum and Cholangitis Sao Paulo Med J. 2003;
121: 173-5.
53. Chandy G, Hart WJ, Roberts-Thomson IC. An Analysis
of the Relationship between Bile Duct Stones and
Periampullary Duodenale Diverticula J. Gastroenterol
Hepatol 1997; 12: 29-33.
54. Egawa N, Kamisawa T, Tu Y, Sakaki N, Tsuru K,
Okamato A. The Role of Juxtapapillary Duodenal
Diverticulum in the Formation of Gallbladder Stones
Hepatogastroenterology, 1998; 45: 917-20.
55. Madanick RD, Barkin JS. Juxtapapillary Duodenal
Diverticula and Biliopancreatic Disease Am J
Gastroenterol 2002; 97: 1834-40.
56. Yıldırgan MI, Basoğlu M, Yılmaz I, Atamanalp SS, Balık
AA, Aydınlı B, Öztürk G. Periampullary Diverticula
Causing Pancreatobiliary Disease Dig Dis Sci 2004; 49:
1943-5.
57. Vassilakis JS, Tzovaras G, Chrysos E, Mouzas I,
Manousos O, Xynos E, Roux-en-Y.
Choledochojejunostomy and Duodenojejunostomy for the
Complicated Duodenal Diverticulum Am J Surg 1997;
174: 45-8.
58. Trondsnen E, Rosseland AR, Baka AO. Surgical
Management of Duodenal Diverticulum Acta Chir Scand
1990; 156: 383-6.

Thank you for copying data from http://www.arastirmax.com