{"id":20862,"date":"2024-06-14T11:25:40","date_gmt":"2024-06-14T11:25:40","guid":{"rendered":"https:\/\/www.tuat.org\/?p=20862"},"modified":"2024-10-07T09:54:33","modified_gmt":"2024-10-07T09:54:33","slug":"air-invasion-rumeysa-bayazit-keskin-rumeysa-bayazit-keskin","status":"publish","type":"post","link":"https:\/\/www.tuat.org\/en\/air-invasion-rumeysa-bayazit-keskin-rumeysa-bayazit-keskin\/","title":{"rendered":"Mysterious Air in the Intestines: Pneumatosis Intestinalis"},"content":{"rendered":"\t\t
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Pn\u00f6matozis \u0130ntestinalis<\/strong><\/h2>\n

Hava! Olmad\u0131\u011f\u0131nda ya\u015fayamayaca\u011f\u0131m\u0131z, 4 temel elementten biri, Marsta y\u0131llard\u0131r aranan, durumuna g\u00f6re giyindi\u011fimiz, \u015f\u00f6\u00f6\u00f6yle derince \u00e7ekti\u011fimiz ve i\u00e7imizde dolanan hava\u2026 Ne kadar i\u00e7imizde??
V\u00fccudumuzdaki hava istilalar\u0131n\u0131 seri halinde aktarmak istedik ve ilk cephesi olarak\u2026
Pn\u00f6matozis intestinalis (PI) kal\u0131n veya ince ba\u011f\u0131rsak duvar\u0131nda hava bulunmas\u0131n\u0131 ifade eder. Mide de etkilenebilir buna da gastrik pn\u00f6matoz denir. Patogenezi hen\u00fcz tam anla\u015f\u0131lamam\u0131\u015ft\u0131r. Bununla ilgili \u00e7e\u015fitli teoriler mevcuttur. Tamamen asemptomatik ya da hayati tehdit edici klinik bulgular\u0131 olabilir. Bu sebeple farkl\u0131 yakla\u015f\u0131mlar sergilenebilir. Kar\u015f\u0131la\u015ft\u0131\u011f\u0131m\u0131zda neye yoraca\u011f\u0131m\u0131z\u0131 daha iyi anlamak i\u00e7in bu hava istilas\u0131n\u0131 gelin yak\u0131ndan tan\u0131yal\u0131m.<\/p>\n

Kimlerde ve neden g\u00f6r\u00fcr\u00fcz?<\/h2>\n

PI, %15 oranla idiopatiktir. Kalan\u0131 gastrointestinal (G\u0130S) ya da G\u0130S kaynakl\u0131 olmayan hastal\u0131klara sekonderdir. Kronik akci\u011fer hastal\u0131klar\u0131, otoimmunite, inflamatuar ba\u011f\u0131rsak hastal\u0131klar\u0131, karsinom, peptik \u00fclser, k\u00fcnt bat\u0131n travmas\u0131, AIDS, Covid-19, TBC, ila\u00e7lar (glukozidaz inh, kortikosteroidler), operasyonlar ve mekanik ventilasyon sebep olabilir. Bebeklerde vakalar\u0131n \u00e7o\u011fu nekrotizan enterekolit kaynakl\u0131d\u0131r.<\/p>\n

Nas\u0131l olu\u015fur?<\/h2>\n

Mekanik teori:<\/strong> Hava ba\u011f\u0131rsak l\u00fcmeni mukozas\u0131ndaki k\u0131r\u0131lmalar yoluyla ba\u011f\u0131rsak duvar\u0131na diseke olur. Bu teoriyi destekleyen baz\u0131 bulgular mevcuttur. Eksize edilmi\u015f kolon segmentine, mukozal insizyonlar yap\u0131l\u0131p hava \u00fcfleyerek PI olu\u015fumu g\u00f6zlenmi\u015ftir. Bu teori iskemi, kostik al\u0131mlar, inflamatuar ba\u011f\u0131rsak hastal\u0131\u011f\u0131, nekrotizan enterekolit gibi hastal\u0131klarda mukozal bozulma olmas\u0131n\u0131 ve PI ili\u015fkisini a\u00e7\u0131klayabilir.
Pulmoner teori:<\/strong> Obstr\u00fcktif akci\u011fer hastal\u0131klar\u0131nda, Covid-19 da oldu\u011fu gibi, havan\u0131n r\u00fcpt\u00fcre olan alveolden, kan damarlar\u0131 boyunca ilerleyerek, ser\u00f6zadan ba\u011f\u0131rsak duvar\u0131na ge\u00e7ti\u011fini ileri s\u00fcrer. Buna kar\u015f\u0131 arg\u00fcmanlarsa, akci\u011ferden ba\u011f\u0131rsaklara do\u011frudan bir gaz yolu olmamas\u0131 ve yap\u0131lan baz\u0131 \u00e7al\u0131\u015fmalarda intestinal hava kistlerinin i\u00e7eri\u011finin, alveollerdeki hava i\u00e7eri\u011finden hidrojen, nitrojen ve karbondioksit bak\u0131m\u0131ndan farkl\u0131 olmas\u0131d\u0131r.
Bakteriyel teori:<\/strong> Ba\u011f\u0131rsaktaki gaz olu\u015fturan bakterilerin mukozal ihlaller ile submukozaya ula\u015fmas\u0131d\u0131r. S\u0131\u00e7anlarla yap\u0131lan bir \u00e7al\u0131\u015fmada C. Perfiringens ba\u011f\u0131rsak duvar\u0131na enjekte edilmi\u015f ve PI olu\u015fmu\u015ftur. Baz\u0131 PI vakalar\u0131n\u0131n antibiyotik kullan\u0131m\u0131 ile tedavi olmas\u0131 bu teoriyi destekler. Bu teoriye kar\u015f\u0131 arg\u00fcman ise hava kistlerinin steril olmas\u0131, y\u0131rt\u0131l\u0131p pn\u00f6moperitonyum olu\u015ftursa dahi genelde peritonit geli\u015fmeden iyi huylu seyretmesidir.
Biyokimyasal teori:<\/strong> Luminal bakterilerin beslenmeyle ili\u015fkili a\u015f\u0131r\u0131 hidrojen \u00fcretmesi ve olu\u015fan gaz\u0131n bas\u0131nc\u0131 artt\u0131k\u00e7a do\u011frudan mukozaya ilerleyip submukozaya s\u0131k\u0131\u015fmas\u0131n\u0131 ileri s\u00fcrer. Ger\u00e7ekten de kistlerin hidrojen i\u00e7eri\u011finin y\u00fcksek oldu\u011fu ve bu hastalara yap\u0131lan nefes testinde hidrojen d\u00fczeyinin kontrol grubuna g\u00f6re y\u00fcksek oldu\u011fu tespit edilmi\u015f.\u00a0<\/p>\n

Acil ba\u015fvurular\u0131<\/h3>\n

Hastalar\u0131n \u00e7o\u011fu asemptomatik olsa da kar\u0131n a\u011fr\u0131s\u0131, kanama, ishal, kab\u0131zl\u0131k, \u015fi\u015fkinlik gibi \u015fikayetlerle acile gelebilirler. Komplikasyonlar geli\u015fmi\u015fse akut bat\u0131n, sepsis tablosu g\u00f6r\u00fclebilir.<\/p>\n

Komplikasyonlar\u0131<\/h3>\n

%3 hastada g\u00f6r\u00fcl\u00fcr. Hava kistlerinin l\u00fcmene yay\u0131lmas\u0131 ile ileus, volvulus, invajinasyon, kistleri kaplayan mukozan\u0131n \u00fclserasyonuna ba\u011fl\u0131 hematokezya g\u00f6r\u00fclebilir. Subserozal kistler r\u00fcpt\u00fcre olursa pn\u00f6moperitonyum g\u00f6r\u00fclebilir. Ve hastalar yanl\u0131\u015fl\u0131kla ba\u011f\u0131rsak perforasyonu olarak de\u011ferlendirilebilir. PI ve portal vende hava bulunmas\u0131 %70 hastada ba\u011f\u0131rsak iskemisini g\u00f6sterir.<\/p>\n

Tan\u0131ma ve de\u011ferlendirme<\/h3>\n

Hastalar\u0131n de\u011ferlendirilmesi \u00f6yk\u00fc, muayene, laboratuvar ve g\u00f6r\u00fcnt\u00fclemeyi i\u00e7ermelidir. Komplikasyon olmad\u0131\u011f\u0131nda muayene genelde normaldir ya da bat\u0131nda \u015fi\u015flik olabilir. Laboratuvar tetkiklerinde l\u00f6kositler, pH, laktat, bikarbonat, AST, ALT, amilaz de\u011ferlerine dikkat edilmelidir.
X ray ile 2\/3 hastaya tan\u0131 konabilir. \u0130ntramural hava do\u011frusal ya da dairesel olabilir. Fakat bu \u015fekilde tan\u0131 koymak zordur. Olu\u015fmu\u015fsa pn\u00f6moperitonyum
(diyafram alt\u0131nda serbest hava) g\u00f6r\u00fclebilir.
Endoskopi esnas\u0131nda tesad\u00fcfen fark edilebilir. Submukozal kistler genelde soluk ya da mavimsi g\u00f6r\u00fcn\u00fcr. Endoskopik USG ile do\u011frulanabilir. Biyopsi al\u0131nmas\u0131 \u00f6nerilir.
Da\u011f\u0131l\u0131m\u0131n\u0131, altta yatan nedeni ve portal ven yay\u0131l\u0131m\u0131 olup olmad\u0131\u011f\u0131n\u0131 saptayabilmek ad\u0131na kontrastl\u0131 abdomen BT g\u00f6r\u00fcnt\u00fcleme yap\u0131l\u0131r. Barsak duvar\u0131na paralel yay\u0131lm\u0131\u015f \u00fcz\u00fcm gibi ya da boncuk gibi kistik hava koleksiyonlar\u0131 g\u00f6r\u00fcl\u00fcr. Akci\u011fer penceresinde daha iyi g\u00f6r\u00fclebilir. Azalm\u0131\u015f duvar kontrast\u0131 ve portal ven\u00f6z havan\u0131n varl\u0131\u011f\u0131 ba\u011f\u0131rsak iskemisini d\u00fc\u015f\u00fcnd\u00fcr\u00fcr. Ancak portal vende hava olan hastalar\u0131n %30\u2019u benign ve idiopatiktir. Pn\u00f6moperitonyum olu\u015fmu\u015fsa bat\u0131n i\u00e7i serbest hava tomografi kesitlerinde saptanabilir.<\/p>\n

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Nas\u0131l tedavi edelim?<\/h2>\n

\u015eunlardan birisi varsa hasta acildir ve cerrahi gerekir;<\/p>\n

\u2022 Akut bat\u0131n muayene bulgusu
\u2022 Metabolik asidoz (pH <7.3, HCO3 <20 mmol\/L)
\u2022 Laktat y\u00fcksekli\u011fi (>2 mmol\/L)
\u2022 Portal vende hava<\/p>\n

E\u011fer akut bat\u0131n d\u00fc\u015f\u00fcnd\u00fcren bulgu yoksa PI kaynakl\u0131 pn\u00f6moperitonyum medikal tedavi edilebilir.
Altta yatan sebep t\u00fcm hastalar i\u00e7in tedavi edilmelidir. Asemptomatikse kendili\u011finden d\u00fczelir. Hafif semptomatik hastalar diyet ve antibiyotik
(metronidazol, 3 ay boyunca, g\u00fcnl\u00fck 3×500 mg) tedavisi almal\u0131d\u0131r.
Orta ve \u015fiddetli semptomlar\u0131 olan hastalar i\u00e7in antibiyotik ve diyete ek olarak 10 g\u00fcn boyunca oksijen tedavisi \u00f6nerilir. Hala devam ederse hiperbarik oksijen tedavisi verilebilir.<\/p>\n

KAYNAKLAR<\/h3>\n

1. Uptodate\/pneumatosis intestinalis<\/p>\n

2. Jaehyuck Im Pneumatosis intestinalis In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. 2023 Apr 27. PMID: 33232051 Bookshelf
ID: NBK564381<\/p>\n

3. Fangmei Ling Pneumatosis cystoides intestinalis: a case report and literat\u00fcre review PMID: 31694581 PMCID: PMC6836417 DOI: 10.1186\/s12876-019-1087-9<\/p>\n

4. Abdullah Ibrahim Portal venous gas and pneumatosis intestinalis: ominous findings with an idiopathic aetiology J Surg Case Rep. 2019 Feb; 2019(2): rjy352. Published online 2019 Feb 8. doi: 10.1093\/jscr\/rjy352 PMCID: PMC6368134 PMID: 30788091<\/p>\n

5. Cihan bedel Pneumatosis cystoides intestinalis: a case report and review of the literature Maltepe T\u0131p Dergisi Cilt: 10 Say\u0131: 2\/2018<\/p>\n<\/figure>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\n

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    \n\t\t\t <\/ul>\n <\/div> \n","protected":false},"excerpt":{"rendered":"

    Pn\u00f6matozis \u0130ntestinalis Air! One of the four basic elements that we cannot live without, sought on Mars for years, the reason we dress according to its condition, the air we deeply inhale and feel inside us\u2026 How much is inside us? We wanted to convey the invasions of air in our body in a series, […]<\/p>\n","protected":false},"author":3,"featured_media":21385,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[115],"tags":[],"class_list":["post-20862","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/posts\/20862","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/comments?post=20862"}],"version-history":[{"count":0,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/posts\/20862\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/media\/21385"}],"wp:attachment":[{"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/media?parent=20862"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/categories?post=20862"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.tuat.org\/en\/wp-json\/wp\/v2\/tags?post=20862"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}