İntestinal Obstruksiyon, İleus, Volvulus
Özet
Acil serviste akut karın ağrısı ile başvuran hastalar arasında intestinal obstrüksiyonlar, tanı ve tedavide gecikme durumunda ciddi morbidite ve mortaliteye yol açabilen önemli klinik tablolardan biridir. İnce ve kalın bağırsak obstrüksiyonları, patofizyolojik olarak mekanik ve fonksiyonel (paralitik ileus) nedenlere bağlı olarak gelişebilir. Mekanik obstrüksiyonlarda bağırsak lümeninde fiziksel bir engel bulunması sonucunda intralüminal basınç artışı meydana gelir ve bu durum strangülasyon, bağırsak iskemisi, nekroz ve perforasyon gibi yaşamı tehdit eden komplikasyonlara yol açabilir. Paralitik ileus ise mekanik bir tıkanıklık olmaksızın bağırsak motilitesinin azalması veya tamamen durması ile karakterizedir ve sıklıkla postoperatif dönem, sepsis veya metabolik bozukluklar ile ilişkilidir. İntestinal obstrüksiyonun klinik bulguları; karın ağrısı, abdominal distansiyon, bulantı-kusma ve gaz-gaita çıkaramama şeklinde ortaya çıkar ve obstrüksiyonun tipi ile yerine göre değişkenlik gösterebilir. Tanıda klinik değerlendirme temel olmakla birlikte, görüntüleme yöntemleri ayırıcı tanı ve komplikasyonların saptanmasında kritik öneme sahiptir. Özellikle kontrastlı abdominal bilgisayarlı tomografi, obstrüksiyonun lokalizasyonunun belirlenmesi, geçiş noktasının gösterilmesi ve strangülasyon bulgularının değerlendirilmesinde temel görüntüleme yöntemi olarak kabul edilmektedir. Volvulus olguları, hızlı klinik progresyon ve yüksek komplikasyon riski nedeniyle ayrı bir öneme sahiptir ve erken tanı ile uygun tedavi yaklaşımı prognozu doğrudan etkilemektedir.
Intestinal obstruction is an important clinical condition among patients presenting to the emergency department with acute abdominal pain and may lead to significant morbidity and mortality if diagnosis and treatment are delayed. Small and large bowel obstructions may develop due to mechanical or functional (paralytic ileus) causes. In mechanical obstruction, the presence of a physical barrier within the bowel lumen results in increased intraluminal pressure, which may lead to life-threatening complications such as strangulation, bowel ischemia, necrosis, and perforation. Paralytic ileus, on the other hand, is characterized by a decrease or complete cessation of bowel motility without a mechanical cause and is commonly associated with postoperative status, sepsis, or metabolic disorders. Clinical manifestations of intestinal obstruction include abdominal pain, abdominal distension, nausea, vomiting, and inability to pass gas or stool, with symptom severity varying according to the type and location of the obstruction. While clinical evaluation plays a central role in diagnosis, imaging modalities are essential for differential diagnosis and for the detection of complications. Contrast-enhanced abdominal computed tomography is regarded as the primary imaging modality for determining the level of obstruction, identifying the transition point, and evaluating signs of strangulation. Volvulus represents a distinct subgroup of mechanical intestinal obstruction, characterized by rapid clinical progression and a high risk of complications; therefore, early diagnosis and appropriate management have a direct impact on patient prognosis.
Referanslar
Catena F, De Simone B, Coccolini F, Sartelli M, Ansaloni L, Di Saverio S, et al. Bowel obstruction:a narrative review for all physicians. World J Emerg Surg. 2019;14:20. doi:10.1186/s13017–019-0240–7
Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83(2):159–165.
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 Education;2019.
Walls RM, Hockberger RS, Gausche-Hill M, editors. Rosen’s Emergency Medicine:Concepts and Clinical Practice. 9th ed. Philadelphia:Elsevier;2018
Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. 2008;92(3):575–597. doi:10.1016/j.mcna.2008.01.003
Teixeira PG, Karamanos E, Talving P, Inaba K, Lam L, Demetriades D. Early operation is associated with a survival benefit for patients with adhesive small bowel obstruction. Ann Surg. 2013;258(3):459–465. doi:10.1097/SLA.0b013e3182a14a3e
Elgar G, Smiley A, Smiley P, Al-Rawi H, Azzam H. Paralytic ileus in hospitalized patients:outcomes and mortality. Int J Environ Res Public Health. 2022;19(16):9905. doi:10.3390/ijerph19169905
Bordeianou L, Yeh DD. Management of small bowel obstruction in adults. In:UpToDate. Waltham (MA):UpToDate Inc.;2025.
Atamanalp SS. Sigmoid volvulus:diagnosis and management. Tech Coloproctol. 2013;17(5):485–489. doi:10.1007/s10151–012-0930–9
Millet I, Ruyer A, Alili C, Curros Doyon F, Molinari N, Pages E, et al. Value of CT findings to predict surgical ischemia in small bowel obstruction. Eur Radiol. 2015;25(6):1823–1835. doi:10.1007/s00330–014-3547–6
Nelms DW, Kann BR. Imaging Modalities for Evaluation of Intestinal Obstruction. Clin Colon Rectal Surg. 2021 Jul;34(4):205–218. doi:10.1055/s-0041–1729737.
O’Mara CS, Wilson TH Jr, Stonesifer GL, Cameron JL. Cecal volvulus:analysis of 50 patients. Surgery. 1979;86(2):261–269.
Bhatnagar BN, Sharma CL, Gupta SN, Mathur MM, Reddy DC. Study on the clinical spectrum of sigmoid volvulus. Dis Colon Rectum. 1985;28(12):919–923.
Perrot L, Fohlen A, Alves A, Lubrano J. Management of the colonic volvulus in 2016. J Visc Surg. 2016;153(3):183–192. doi:10.1016/j.jviscsurg.2016.03.006
Kahi CJ, Rex DK. Bowel obstruction and volvulus. Gastroenterol Clin North Am. 2003;32(4):1229–1247. doi:10.1016/S0889–8553(03)00074–8
Consorti ET, Liu TH. Diagnosis and treatment of caecal volvulus. Postgrad Med J. 2005;81(962):772–776. doi:10.1136/pgmj.2005.035311
Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010;12(7):e1–e17. doi:10.1111/j.1463–1318.2010.02262.x
Huang JC, Shin JS, Huang YT, Wu TC, Lee CH. CT findings of sigmoid volvulus. AJR Am J Roentgenol. 2004;182(5):1183–1187. doi:10.2214/ajr.182.5.1821183
Zins M, Millet I, Taourel P. Adhesive small bowel obstruction:predictive radiology to improve patient management. Radiology. 2020;296(3):480–492.doi:10.1148/radiol.2020192234.
Wong M, Jeffrey RB, Rucker AN, Olcott EW. Ileocolic vascular curvature:a new CT finding of cecal volvulus. Abdom Radiol (NY). 2020 Oct;45(10):3057–3064. doi:10.1007/s00261–020-02491-w.
Referanslar
Catena F, De Simone B, Coccolini F, Sartelli M, Ansaloni L, Di Saverio S, et al. Bowel obstruction:a narrative review for all physicians. World J Emerg Surg. 2019;14:20. doi:10.1186/s13017–019-0240–7
Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83(2):159–165.
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 Education;2019.
Walls RM, Hockberger RS, Gausche-Hill M, editors. Rosen’s Emergency Medicine:Concepts and Clinical Practice. 9th ed. Philadelphia:Elsevier;2018
Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. 2008;92(3):575–597. doi:10.1016/j.mcna.2008.01.003
Teixeira PG, Karamanos E, Talving P, Inaba K, Lam L, Demetriades D. Early operation is associated with a survival benefit for patients with adhesive small bowel obstruction. Ann Surg. 2013;258(3):459–465. doi:10.1097/SLA.0b013e3182a14a3e
Elgar G, Smiley A, Smiley P, Al-Rawi H, Azzam H. Paralytic ileus in hospitalized patients:outcomes and mortality. Int J Environ Res Public Health. 2022;19(16):9905. doi:10.3390/ijerph19169905
Bordeianou L, Yeh DD. Management of small bowel obstruction in adults. In:UpToDate. Waltham (MA):UpToDate Inc.;2025.
Atamanalp SS. Sigmoid volvulus:diagnosis and management. Tech Coloproctol. 2013;17(5):485–489. doi:10.1007/s10151–012-0930–9
Millet I, Ruyer A, Alili C, Curros Doyon F, Molinari N, Pages E, et al. Value of CT findings to predict surgical ischemia in small bowel obstruction. Eur Radiol. 2015;25(6):1823–1835. doi:10.1007/s00330–014-3547–6
Nelms DW, Kann BR. Imaging Modalities for Evaluation of Intestinal Obstruction. Clin Colon Rectal Surg. 2021 Jul;34(4):205–218. doi:10.1055/s-0041–1729737.
O’Mara CS, Wilson TH Jr, Stonesifer GL, Cameron JL. Cecal volvulus:analysis of 50 patients. Surgery. 1979;86(2):261–269.
Bhatnagar BN, Sharma CL, Gupta SN, Mathur MM, Reddy DC. Study on the clinical spectrum of sigmoid volvulus. Dis Colon Rectum. 1985;28(12):919–923.
Perrot L, Fohlen A, Alves A, Lubrano J. Management of the colonic volvulus in 2016. J Visc Surg. 2016;153(3):183–192. doi:10.1016/j.jviscsurg.2016.03.006
Kahi CJ, Rex DK. Bowel obstruction and volvulus. Gastroenterol Clin North Am. 2003;32(4):1229–1247. doi:10.1016/S0889–8553(03)00074–8
Consorti ET, Liu TH. Diagnosis and treatment of caecal volvulus. Postgrad Med J. 2005;81(962):772–776. doi:10.1136/pgmj.2005.035311
Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010;12(7):e1–e17. doi:10.1111/j.1463–1318.2010.02262.x
Huang JC, Shin JS, Huang YT, Wu TC, Lee CH. CT findings of sigmoid volvulus. AJR Am J Roentgenol. 2004;182(5):1183–1187. doi:10.2214/ajr.182.5.1821183
Zins M, Millet I, Taourel P. Adhesive small bowel obstruction:predictive radiology to improve patient management. Radiology. 2020;296(3):480–492.doi:10.1148/radiol.2020192234.
Wong M, Jeffrey RB, Rucker AN, Olcott EW. Ileocolic vascular curvature:a new CT finding of cecal volvulus. Abdom Radiol (NY). 2020 Oct;45(10):3057–3064. doi:10.1007/s00261–020-02491-w.
