Stapler Hemoroidopeksi Sonrası Gelişen Hemoroidal Nekroz
Özet
Hemoroidal hastalık, anal yastıkçıkların semptomatik genişlemesi ve prolapsusu ile karakterize, toplumda sık görülen benign bir anorektal patolojidir. İleri evre (Grade 3–4) hemoroidal hastalığın tedavisinde stapler hemoroidopeksi, daha az postoperatif ağrı ve hızlı iyileşme avantajları nedeniyle yaygın olarak kullanılan cerrahi yöntemlerden biridir. Bununla birlikte, nadir fakat ciddi komplikasyonlar gelişebilmektedir. Bu olgu sunumunda, stapler hemoroidopeksi sonrası hemoroid paketlerinde gelişen yaygın mukozal nekroz olgusu ele alınmıştır. Altmış yaşında erkek hastaya mukozal prolapsusla seyreden Grade 4 internal hemoroidal hastalık nedeniyle stapler hemoroidopeksi uygulanmıştır. Postoperatif 48. saatte artan anal ağrı ile başvuran hastada, anestezi altında yapılan muayenede hemoroid paketlerinde belirgin ödem ve mukozal nekroz saptanmıştır. Stapler hattı intakt izlenmiş, nekrotik dokular seri debridman ve lokal bakım ile tedavi edilmiştir. Klinik ve laboratuvar bulguları gerileyen hasta komplikasyonsuz şekilde taburcu edilmiştir. Stapler hemoroidopeksi sonrası gelişen şiddetli ağrının ayırıcı tanısında hemoroidal nekrozun akılda tutulması, erken tanı ve uygun cerrahi müdahale ile ciddi morbiditelerin önlenmesi açısından önemlidir.
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