Gastroşizis: Prenatal Tanı, Cerrahi Yönetim ve Olgu Eşliğinde Güncel Yaklaşım
Özet
Gastroşizis, prenatal dönemde başlayan ve doğum sonrası cerrahi onarım ile yoğun bakım sürecini gerektiren konjenital bir ön karın duvarı defektidir. Prenatal tanı ve neonatal yoğun bakım olanaklarındaki gelişmelere rağmen özellikle kompleks olgularda morbidite önemli bir sorun olmaya devam etmektedir. Prognoz; bağırsak hasarının derecesi, eşlik eden intestinal anomaliler ve cerrahi yaklaşımın uygun seçimi ile yakından ilişkilidir. Prenatal tanı, doğumun planlanması ve multidisipliner yaklaşımın organizasyonu açısından kritik öneme sahiptir. Doğum zamanlaması bireyselleştirilmekle birlikte genellikle 37. gebelik haftası civarı tercih edilmektedir. Cerrahi tedavide primer kapama ve silo uygulaması hasta özelliklerine göre seçilir; intraabdominal basınç ve bağırsak ödemi belirleyicidir. Postnatal dönemde ısı ve sıvı kaybının önlenmesi, resüsitasyon, enfeksiyon kontrolü ve erken enteral beslenme tedavinin temelini oluşturur. Sunulan olgu, prenatal tanı ve multidisipliner yönetim sayesinde komplikasyonsuz bir seyir göstermiştir.
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