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Læknablaðið - 01.02.2017, Blaðsíða 21

Læknablaðið - 01.02.2017, Blaðsíða 21
LÆKNAblaðið 2017/103 77 R A N N S Ó K N ráð fyrir að sjúklingar sem fóru beint í aðgerð hafi verið veikari en þeir sem fengu stuðningsmeðferð. Þar sem ASA-skor var illa skráð og sjúklingar ekki flokkaðir í undirflokka eftir alvarleika einkenna, var ekki hægt að styðja það með gögnum. Það verður því að hafa í huga við allan samanburð að hóparnir geta verið mjög ólíkir. Margbreytileiki hópsins er einnig helsti styrkur þessarar rann- sóknar. Rannsóknin nær til allra sjúklinga með rof á ristli á Ís- landi á rannsóknartímabilinu, þar sem gera má ráð fyrir að önnur sjúkrahús en þau sem tóku þátt meðhöndli ekki sjúklinga sem uppfylla inntökuskilyrði. Rannsóknin er með bæði langt rann- sóknartímabil og mikinn fjölda sjúklinga og gefur því góða mynd af þessu alvarlega vandamáli sem rof á ristli er hér á landi, orsök- um þess og árangri meðferðar. Þakkir Höfundar vilja þakka riturum þeirra sjúkrahúsa sem þátt tóku fyrir hjálp við að afla gagna. Sérstakar þakkir fær Gunnhildur Jóhannsdóttir, Landspítala, og Hjörtur Brynjólfsson, læknir á Sjúkrahúsinu á Akureyri. Þá fá Martin Ingi Sigurðsson og Sigrún Helga Lund þakkir fyrir veitta tölfræðiaðstoð. ENGLISH SUMMARY Introduction: Colon perforation is a serious illness with mortality report- ed from 0-39%. Surgery used to be the gold standard but treatment has changed as studies have indicated comparable results with less invasive treatment. The aim of this study was to evaluate the incidence of acute colon perforations in Iceland, causes and treatment. Material and methods: A retrospective, nationwide, multicenter analy- sis was performed based on ICD-10 codes from databases of the main hospitals in Iceland. Age, gender, year of perforation, cause, means of diagnosis, treatment and outcome were registered. Patients under 18 years and post mortem diagnosis were excluded. Results: 225 patients met criteria, 131 women (58%) and 94 men (42%), median age 70 years (range 30-95). The most common causes were diverticulitis (67%), colonoscopy (12%) and complications during opera- tions (5%). During the first five study years, 27% received conservative treatment while 71% underwent surgery. By the end of the study era this ratio was 45% and 54% respectively. The rate of permanent stoma was 10%. Conclusions: Diverticulitis was the most common cause of colon per- foration in Iceland during the study period. Many patients still undergo surgery but there has been a dramatic change toward more conservative treatment. The rate of stoma closure is comparable to studies else- where. Incidence, cause and treatment of colonic perforations in Iceland 1998-2007: A nationwide study Kristín Jónsdóttir1, Elsa B. Valsdóttir2, Shreekrishna Datye3, Fritz Berndsen4, Páll Helgi Möller1,2 1University Hospital of Iceland, Dept. General Surgery, 2University of Iceland, Faculty of Medicine, 3Akureyri Teaching Hospital, 4Akranes Hospital and Health Care Center, Iceland. Key words: Colon perforation, diverticulitis, Hartmann’s reversal. Correspondence: Elsa B. Valsdóttir, elsava@landspitali.is Heimildir 1. Sheth AA, Longo W, Floch MH. Diverticular Disease and Diverticulitis. Am J Gastroenterol 2008;103: 1550-6. 2. Biondo S, Parés D, Ragué JM, Oca J, Toral D, Borobia FG, et al. Emergency operation for Nondiverticular perforation of the left colon. Am J Surg 2002; 183: 256-60. 3. Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 2008; 143: 701-7. 4. Lüning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007; 21: 994-7. 5. Panteris V, Haringsma J, Kuipers EJ. Colonoscopy per- foration rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy 2009; 41: 941-51. 6. Sosna J, Blachar A, Amitai M, Barmeir E, Peled N, Goldberg SN, et al. Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology 2006; 239: 457-63. 7. Tulchinsky H, Madhala-Givon O, Wasserberg N, Lelcuk S, Niv Y. Incidence and management of colonoscopic per- forations: 8 years‘ experience. World J Gastroenterol 2006; 12: 4211-3. 8. Vermeulen J, Coene PP, Van Hout NM, van der Harst E, Gosselink MP, Mannaerts GH, et al. Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann‘s procedure be considered a one-stage procedure? Colorectal Dis 2009; 11: 619-24. 9. Toro A, Mannino M, Reale G, Capello G, Di Carlo I. Primary anastomosis vs. Hartmann procedure in acute complicated diverticulitis. Evolution over the last twenty years. Chirurgia (Bucur) 2012; 107: 598-604. 10. Oomen JL, Cuesta MA, Engel AF. Reversal of Hartmann‘s procedure after surgery for complications of diverticular disease of the sigmoid colon is safe and possible in most patients. Dig Surg 2005; 22: 419-25. 11. Chandra V, Nelson H, Larson DR, Harrington JR. Impact of primary resection on the outcome of patients with per- forated diverticulitis. Arch Surg 2004; 139: 1221-4. 12. Durmishi Y, Gervaz P, Brandt D, Bucher P, Platon A, Morel P, et al. Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computer tomography scan. Surg Endosc 2006; 20: 1129-33. 13. Fingerhut A, Veyrie N. Complicated diverticular disease: the changing paradigm for treatment. Rev Col Bras Cir 2012; 39: 322-7. 14. Karoui M, Champault A, Pautrat K, Valleur P, Cherqui D, Champault G. Laparascopic peritoneal lavage or primary anastamosis with defunctioning stoma for hinchey 3 complicated diverticulitis: results of a comparative study. Dis Colon Rectum 2009; 52: 609-15. 15. Toorenvliet BR, Swank H, Schoones JW, Haming JF, Bemelman WA. Laparoscopic peritoneal lavage for per- forated colonic diverticulitis: systematic review. Colorectal Dis 2010; 12: 862-7. 16. Morris CR, Harvey IM, Stebbing WS, Hart AR. Incidence of perforated diverticulitis and risk factors for death in a UK population. Br J Surg 2008; 95: 876-81. 17. Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Purkayastha S, Remzi FH, et al. Primary resection with anastamosis vs. Hartmann’s procedure in nonelective sur- gery for acute colonic diverticulitis: a systematic review. Dis Colon Rectum 2006; 49: 966-81. 18. Trecca A, Gaj F, Gagliardi G. Our experience with endoscopic repair of large colonoscopic perforations and review of the literature. Tech Coloproctol 2008; 12: 315-21. 19. Feingold D et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 2014; 57: 284-94. 20. Vermeulen J, Gosselink MP, Busschback JJ, Lange JF. Avoiding or reversing Hartmann’s procedure provides improved quality of life after perforated diverticulitis. J Gastrointest Surg 2010; 14: 651-7. 21. Hodgson R, An V, Stupart DA, Guest GD, Watters DA. Who gets Hartmann´s reversed in a regional centre? Surgeon 2016; 14: 184-9. 22. Ricciardi R, Baxter NN, Read TE, Marcello PW, Hall J, Roberts PL. Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticultis? Dis Colon Rectum 2009; 52: 1558-63.

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