Akut Karın Sendromu Nedir, Ne Değildir?
Özet
Akut karın, özgül bir tanıdan ziyade, altta yatan nedeni ne olursa olsun hızlı değerlendirme ve zamanında müdahale gerektiren bir klinik alarm durumudur. İnflamatuvar, iskemik, obstrüktif ve perforatif süreçler akut karın sendromunun temel patofizyolojik mekanizmalarını oluşturur. Erken dönemde klinik bulgular silik olabilir ve her karın ağrısı akut karın anlamına gelmez. Görüntüleme yöntemleri tanısal süreci desteklese de klinik değerlendirme önceliğini korur. Doğru yönetim, gereksiz cerrahi girişimlerin önlenmesi ile gecikmiş tanının azaltılması arasındaki hassas dengeyi gerektirir.
Acute abdomen is not a single diagnosis but a clinical alarm condition requiring rapid evaluation and timely intervention regardless of the underlying etiology. Inflammatory, ischemic, obstructive, and perforative processes constitute the principal pathophysiological mechanisms. Early clinical findings may be subtle, and not all abdominal pain represents an acute abdomen. Although imaging modalities support diagnosis, clinical assessment remains fundamental. Optimal management requires a careful balance between preventing unnecessary surgical interventions and avoiding delayed diagnosis.
Referanslar
Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine. 2012;5:789–797. doi:10.2147/IJGM.S25936.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. American Family Physician. 2008;77(7):971–978.
Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emergency Medicine Clinics of North America. 2003;21(1):61–72. doi:10.1016/S0733-8627(02)00093-3.
Silen W, Cope Z. Cope’s Early Diagnosis of the Acute Abdomen. 22nd ed. Oxford: Oxford University Press; 2010.
Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill; 2020.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 21st ed. Philadelphia: Elsevier; 2021.
Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al. Schwartz’s Principles of Surgery. 12th ed. New York: McGraw-Hill; 2022.
Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 2020;15:27. doi:10.1186/s13017-020-00306-3.
Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan FM, et al. 2020 update of the WSES guidelines for management of acute colonic diverticulitis. World Journal of Emergency Surgery. 2020;15:32. doi:10.1186/s13017-020-00313-4.
Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle TC, Abu-Zidan FM, Ansaloni L, et al. The management of intra-abdominal infections. World Journal of Emergency Surgery. 2017;12:29. doi:10.1186/s13017-017-0141-6.
Scheirey CD, Fowler KJ, Therrien JA, Kim DH, Blake MA, Rosen MP, et al. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. Journal of the American College of Radiology. 2018;15(11S):S217–S231. doi:10.1016/j.jacr.2018.09.010.
Garcia EM, Camacho MA, Karolyi DR, Kim DH, Cash BD, Rosen MP, et al. ACR Appropriateness Criteria® Right Lower Quadrant Pain–Suspected Appendicitis. Journal of the American College of Radiology. 2018;15(11S):S373–S387. doi:10.1016/j.jacr.2018.09.033.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine. 1986;15(5):557–564.
Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score: a systematic review. BMC Medicine. 2011;9:139. doi:10.1186/1741-7015-9-139.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278–1287. doi:10.1016/S0140-6736(15)00275-5.
Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Archives of Internal Medicine. 2004;164(10):1054–1062. doi:10.1001/archinte.164.10.1054.
Bala M, Kashuk J, Moore EE, Kluger Y, Biffl WL, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery. 2017;12:38. doi:10.1186/s13017-017-0150-5.
Clair DG, Beach JM. Mesenteric ischemia. New England Journal of Medicine. 2016;374:959–968. doi:10.1056/NEJMra1503884.
Referanslar
Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine. 2012;5:789–797. doi:10.2147/IJGM.S25936.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. American Family Physician. 2008;77(7):971–978.
Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emergency Medicine Clinics of North America. 2003;21(1):61–72. doi:10.1016/S0733-8627(02)00093-3.
Silen W, Cope Z. Cope’s Early Diagnosis of the Acute Abdomen. 22nd ed. Oxford: Oxford University Press; 2010.
Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill; 2020.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 21st ed. Philadelphia: Elsevier; 2021.
Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al. Schwartz’s Principles of Surgery. 12th ed. New York: McGraw-Hill; 2022.
Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 2020;15:27. doi:10.1186/s13017-020-00306-3.
Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan FM, et al. 2020 update of the WSES guidelines for management of acute colonic diverticulitis. World Journal of Emergency Surgery. 2020;15:32. doi:10.1186/s13017-020-00313-4.
Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle TC, Abu-Zidan FM, Ansaloni L, et al. The management of intra-abdominal infections. World Journal of Emergency Surgery. 2017;12:29. doi:10.1186/s13017-017-0141-6.
Scheirey CD, Fowler KJ, Therrien JA, Kim DH, Blake MA, Rosen MP, et al. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. Journal of the American College of Radiology. 2018;15(11S):S217–S231. doi:10.1016/j.jacr.2018.09.010.
Garcia EM, Camacho MA, Karolyi DR, Kim DH, Cash BD, Rosen MP, et al. ACR Appropriateness Criteria® Right Lower Quadrant Pain–Suspected Appendicitis. Journal of the American College of Radiology. 2018;15(11S):S373–S387. doi:10.1016/j.jacr.2018.09.033.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine. 1986;15(5):557–564.
Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score: a systematic review. BMC Medicine. 2011;9:139. doi:10.1186/1741-7015-9-139.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278–1287. doi:10.1016/S0140-6736(15)00275-5.
Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Archives of Internal Medicine. 2004;164(10):1054–1062. doi:10.1001/archinte.164.10.1054.
Bala M, Kashuk J, Moore EE, Kluger Y, Biffl WL, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery. 2017;12:38. doi:10.1186/s13017-017-0150-5.
Clair DG, Beach JM. Mesenteric ischemia. New England Journal of Medicine. 2016;374:959–968. doi:10.1056/NEJMra1503884.
