Mezenter Arter Trombozu Sonrası İnce barsak Nekrozu: Postoperatif Uzun Dönemde Anastomoz Kaçağı

Mezenter arter embolisi genellikle kardiyak problemlere sekonder olusmaktadir. Acil olgular icerisinde onemli derecede morbidite ve mortalite sebebidir. Mezenter arter iskemisi nedeni ile gastrointeatinal sistem (GIS)  cerrahisi yapilan hastalarda ortaya cikan anastomoz kacaklari yuksek morbidite ve mortaliteye neden olmaktadir. Yeni operasyon tekniklerin kullanilmasi, operasyon oncesi hasta hazirliginda ve postoperatif hasta takibinde gostrerilen ozene ek olarak gelistirilen teknikler, metabolik parametrelerin duzeltilmesi ve peroperatif vaskularisazyona ozen gosterilmesiyle son yillarda fistul insidansi giderek azaltilmistir. Anastomoz kacagi  sonucu gelisen safra fistulunde octreotit tedavisine dramatik cevap bircok calismada bildirilmistir. Hastamizda tespit edilmis herhangi bir kardiyak problem bulunmamaktadir. Mezenter arter iskemisi nedeni ile yapilan GIS anastomozunda gelisen gec anastomoz kacagi olgunun one cikan ozelligidir. IV-oral replasmana ragmen inatci potasyum dusuklugu ve albumin dusuklugu hastamizda dikkati cekmektedir. IV-oral replasmanlarla bu eksiklikler yerine konmaya calisilirken sag bacakta DVT gelismistir. Hastamizda gelisen 2000 cc debisi olan safra fistulu, 10 gun octreotit tedavisi ile intravenoz total parenteral nutrisyon  verilmesi uzerine debisi azalarak postoperatif  20.  gunde fistul kapanmistir.Ve oral beslenmeye baslanmistir. Ancak hipopotasemi ve hipo albuminemi tablosu tum replasmanlarilarimiza ragmen duzelmemistir. Anahtar kelimeler: Mezenter arter trombozu, anastomoz kacagi, safra fistulu, hipopotasemi, hipoalbuminemi. Abstract Mesenteric artery embolism often occurs secondarily to cardiac problems. In emergencies, it is a significant cause of morbidity and mortality. Anastomotic leakage occurring in patients who undergo surgery for gastrointestinal system (GIS) due to mesenteric artery ischemia causes high morbidity and mortality.The use of new surgical techniques, the techniques developed in addition to preoperative patient preparation and the follow-up patients care after surgery, correction of metabolic parameters, and the care for preoperative vascularisation have  gradually reduced the incidence of fistula in recent years. Dramatic response to the octreotide treatment in the biliary fistula caused by anastomosis has been reported in many studies. Our patient did not have any cardiac problems.  The late anastomotic leakage developing in the  gastrointestinal anastomosis performed because of the mesenteric artery ischemia is the highlight of the case. In spite of IV-oral replacement, refractory potassium impairment and low albumin are noteworthy in our patients. While these deficiencies were being supplemented through IV- oral replacements, DVT developed in the right leg. The biliary fistula with the debit of 2000 cc occurring in our patient was treated with 10 days of octreotit treatment of intravenous total parenteral nutrition, and the debit increased and fistula was closed on the 20th postoperative day. Then, oral nutrition was started. However, the table of hypopotassemia and hypoalbuminemia was not rehabilitated, despite all our replacements. Keywords: Mesenteric artery thrombosis, anastomotic leakage, biliary fistula, hypopotassemia hypoalbuminemia