Laparoskopik Kolesistektomi Sonrası Gelişen Safra Yolu Yaralanmasında Erken Dönem Rekonstrüksiyon
Özet
47 yaşında erkek hasta dış merkezde kolelitiazis nedeniyle elektif kolesistektomi operasyonu uygulanmış .Postoperatif 1. Gününde hastanın devam eden karın ağrısı ve sarılık şikayetleri olması üzerine tarafımıza yönlendirildi Yapılan laboratuar testlerinde WBC(beyaz küre sayısı) 12,58 x10³/µL ,Hb (hemoglobin)14,4 g/dL ,PLT (trombosit sayısı)592,000 /µL, ALT: 159 U/L ,AST: 107 U/L ,GGT: 983 U/L ,ALP: 474 U/L ,LDH: 268 U/L ,Total bilirubin: 7,6 mg/dL Direkt bilirubin: 5,54 mg/dL Amilaz: 47 U/L INR: 1,06 olarak saptandı. Hastaya postoperatif 36. Saatte çekilen MRCP(manyetik rezonans kolanjiopanktreografi) görüntülemesinde ise intrahepatik safra yollarının dilate olduğu ve koledok proksimal kesiminde kesintiye uğradığı ve koledok distalinin net olarak değerlendirilemediği görüldü.Yapılan radyolojik değerlendirmede eşlik eden Sağ hepatik arter yaralanması mevcuttu. Hastaya postoperatif 48. Saatte Roux-N-Y Hepatikojejunostomi prosedürü gerçekleştirildi. Postoperatif 6. Gününde hasta taburcu edildi.
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