Endometriozis ve Acil Durumlar
Synopsis
Endometriozis genellikle kronik pelvik ağrı ve infertilite ile ilişkilendirilse de, nadir de olsa ani gelişen acil durumlara da yol açabilir. Bu acil durumlar, akut karın ağrısı, bağırsak obstrüksiyonu , intraperitoneal kanama ve hatta gebelik sırasında gelişen komplikasyonlar şeklinde ortaya çıkabilir.Endometriozisin acil servislere başvuran hastalarda teşhis edilmesi zordur çünkü semptomları sıklıkla apandisit, divertikülit ya da över kisti rüptürü gibi diğer karın içi hastalıklarla karıştırılır. Bu yanlış teşhisler tanı ve tedavi süreçlerinin gecikmesine yol açar, bu da hastanın durumu kötüleşmeden önce doğru müdahaleyi zorlaştırır. Özellikle mens döngüsünün belirli dönemlerinde ve gebelik sırasında ortaya çıkan intraperitoneal kanamalar hayatı tehdit edebilir ve acil cerrahi müdahale gerektirebilir. Endometriozis vakalarının bu gibi durumlarda erken teşhis edilmesi ve doğru müdahalenin zamanında yapılması, hastanın hayatta kalma oranlarını ve yaşam kalitesini artırabilir.Bu bölüm endometriozisin acil durumlarla nasıl ortaya çıkabileceğini, teşhis ve tedavi süreçlerindeki zorlukları ve bu durumların nasıl yönetilebileceğini ele almaktadır. Klinik yönetimde erken tanı, doğru klinik değerlendirme ve uygun cerrahi müdahaleler, endometriozis kaynaklı acil durumların önlenmesinde ve tedavi edilmesinde hayati önem taşımaktadır. Ayrıca, endometriozisin acil servislerde daha iyi tanınması ve tanı gecikmelerinin önlenmesi için sağlık çalışanlarının bilinçlendirilmesi gerekmektedir.
Although endometriosis is usually associated with chronic pelvic pain and infertility, it can also cause sudden emergencies, although rare. These emergencies can occur in the form of acute abdominal pain, intestinal obstruction, intraperitoneal bleeding, and even complications during pregnancy. Endometriosis is difficult to diagnose in patients presenting to emergency departments because its symptoms are often confused with other intra-abdominal diseases such as appendicitis, diverticulitis, or ruptured ovarian cysts. These misdiagnoses lead to delayed diagnosis and treatment, making it difficult to intervene correctly before the patient's condition worsens. Intraperitoneal bleeding, especially during certain periods of the menstrual cycle and during pregnancy, can be life-threatening and require emergency surgery. Early diagnosis of endometriosis cases and timely intervention can increase the patient's survival rate and quality of life. This section discusses how endometriosis can present as emergencies, the difficulties in diagnosis and treatment, and how these conditions can be managed. Early diagnosis, accurate clinical assessment and appropriate surgical interventions are vital in preventing and treating endometriosis emergencies in clinical management. In addition, healthcare professionals need to be made aware of endometriosis in emergency services to better recognize it and prevent diagnostic delays.
References
Passos, F., Calhaz-Jorge, C., & Graça, L. (2008). Endometriosis is a possible risk factor for spon¬taneous hemoperitoneum in the third trimester of pregnancy.. Fer¬tility and sterility, 89 1, 251-2 . ht¬tps://doi.org/10.1016/J.FERTNS¬TERT.2007.02.009.
Lier, M., Malik, R., Ket, J., Lam¬balk, C., Brosens, I., & Mijatovic, V. (2017). Spontaneous hemoperito¬neum in pregnancy (SHiP) and en¬dometriosis - A systematic review of the recent literature.. European journal of obstetrics, gynecology, and reproductive biology, 219, 57-65. https://doi.org/10.1016/j.ejogrb.2017.10.012.
Katorza, E., Soriano, D., Stockheim, D., Mashiach, R., Zolti, M., Seid¬man, D., Schiff, E., & Goldenberg, M. (2007). Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy.. American journal of obstetrics and gynecology, 197 5, 501.e1-4 . https://doi.org/10.1016/J.AJOG.2007.04.030.
Brosens, I., Lier, M., Mijatovic, V., Habiba, M., & Benagiano, G. (2016). Severe spontaneous hemoperito¬neum in pregnancy may be linked to in vitro fertilization in patients with endometriosis: a systematic review.. Fertility and sterility, 106 3, 692-703 . https://doi.org/10.1016/j.fertnstert.2016.05.025.
Kim, T., Sudhof, L., Liu, F., & Sha¬inker, S. (2020). Spontaneous he¬moperitoneum in pregnancy due to endometriosis. Journal of En¬dometriosis and Pelvic Pain Di¬sorders, 12, 124 - 127. https://doi.org/10.1177/2284026520942432.
Palaia, I., Bardhi, E., Boccia, S., Pe¬corini, F., Musella, A., & Panici, P. (2020). Severe hemoperitoneum due to endometriosis in a non-preg¬nant woman under dienogest the-rapy: a case report. Gynecological Endocrinology, 36, 211 - 212. https://doi.org/10.1080/09513590.201 9.1653843.
Buggio, L., Aimi, G., & Vercelli¬ni, P. (2016). Hemoperitoneum Following Sexual Intercourse in a Woman with Deep Infiltrating En¬dometriosis. Gynecologic and Obs¬tetric Investigation, 81, 559 - 562. https://doi.org/10.1159/000447262.
Costa, A., Sartini, A., Garibaldi, S., & Cencini, M. (2014). Deep Endometriosis Induced Sponta¬neous Colon Rectal Perforation in Pregnancy: Laparoscopy Is Ad¬vanced Tool to Confirm Diag¬nosis. Case Reports in Obstetrics and Gynecology, 2014. https://doi.org/10.1155/2014/907150.
Nishikawa, A., Kondoh, E., Hama¬nishi, J., Yamaguchi, K., Ueda, A., Sato, Y., & Konishi, I. (2013). Ileal perforation and massive intesti¬nal haemorrhage from endomet¬riosis in pregnancy: case report and literature review.. European journal of obstetrics, gynecology, and reproductive biology, 170 1, 20-4. https://doi.org/10.1016/j.ejogrb.2013.04.018.
Gs, L., Im, S., & Ha, H. (1988). Sigmoid colon perforation due to endometriosis not associated with pregnancy.. The American Journal of Gastroenterology, 83, 1424.
Torralba-Morón A, Urbanowicz M, Ibarrola-De Andres C, Lo¬pez-Alonso G, Colina-Ruizdelgado F, Guerra-Vales JM. Acute Small Bowel Obstruction and Small Bowel Perforation as a Clinical Debut of Intestinal Endometriosis: A Report of Four Cases and Re-view of the Literature. Intern Med. 2016;55(18):2595-9. doi: 10.2169/internalmedicine.55.6461.
Huang, Y., Liou, J., Hsieh, C., Shi¬au, C., Lo, L., & Chang, M. (2011). Long-term follow-up of patients surgically treated for ruptured ovarian endometriotic cysts.. Ta¬iwanese journal of obstetrics & gy¬necology, 50 3, 306-11 . https://doi.org/10.1016/j.tjog.2010.05.002.
Tokita, S., Kumakiri, J., Jinushi, M., Matsuoka, S., Kikuchi, I., Kitade, M., & Takeda, S. (2010). Feasibi¬lity study of laparoscopic surgery for ovarian endometrioma rupture. Japanese Journal of Gynecologic and Obstetric Endoscopy, 26, 600- 604. https://doi.org/10.5180/JS¬GOE.26.600.
Ryazanov, V., Sadykova, G., Zhe¬leznyak, I., Boykov, I., Ipatov, V., & Postanogov, R. (2023). Diagnostic imaging of ovarian endometrioma rupture with hemoperitoneum. Russian Military Medical Academy Reports. https://doi.org/10.17816/rmmar340778.
Seracchioli, R., Manuzzi, L., Mabrouk, M., Solfrini, S., Frascà, C., Manferrari, F., Pierangeli, F., Paradisi, R., & Venturoli, S. (2010). A multidisciplinary, minimally in¬vasive approach for complicated deep infiltrating endometriosis.. Fertility and sterility, 93 3, 1007. e1-3 . https://doi.org/10.1016/j.fert¬nstert.2009.09.058.
Dubernard, G., Rouzier, R., Da¬vid-Montefiore, E., Bazot, M., & Daraï, E. (2008). Urinary compli¬cations after surgery for posterior deep infiltrating endometriosis are related to the extent of dissection and to uterosacral ligaments resec¬tion.. Journal of minimally invasive gynecology, 15 2, 235-40 . https://doi.org/10.1016/j.jmig.2007.10.009.
Mabrouk, M., Arena, A., Moro, E., Raimondo, D., & Seracchioli, R. (2020). Deep Infiltrating En¬dometriosis and spontaneous he¬moperitoneum: a life-threatening situation treated by laparoscopy.. Journal of minimally invasive gy¬necology. https://doi.org/10.1016/j.jmig.2019.07.020.
Lenz, J., Fiala, L., Chvátal, R., Tibon, J., Uncapher, L., Kavka, M., & Čížek, P. (2019). Rectal perforation caused by deep infiltrating endometriosis in non-pregnant woman: Case re-port and short review of the litera¬ture.. Annali italiani di chirurgia, 8.
Kondo, W., Bourdel, N., Zomer, M., Slim, K., Botchorischvili, R., Rabischong, B., Mage, G., & Canis, M. (2013). Surgery for deep infiltra¬ting endometriosis: technique and rationale.. Frontiers in bioscience, 5, 316-32 . https://doi.org/10.2741/E618.
Nadeau, C., Mcghee, S., & Gonza¬lez, J. (2021). Endometriosis: a gu¬ide to investigations and treatment in the emergency department.. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association. https://doi.org/10.7748/en.2021.e2110.
Johnston, J., Reid, H., & Hunter, D. (2015). Diagnosing endometriosis in primary care: clinical update.. The British journal of general prac¬tice : the journal of the Royal Colle¬ge of General Practitioners, 65 631, 101-2 . https://doi.org/10.3399/bj¬gp15X683665.
Maggiore, U., Ferrero, S., Mangili, G., Bergamini, A., Inversetti, A., Gi¬orgione, V., Viganò, P., & Candiani, M. (2016). A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, comp¬lications and outcomes.. Human reproduction update, 22 1, 70-103. https://doi.org/10.1093/humupd/dmv045.
Coratti, F., Vannuccini, S., Foppa, C., Staderini, F., Coratti, A., Cianc¬hi, F., & Petraglia, F. (2020). Emer¬gency surgery for appendectomy and incidental diagnosis of super¬ficial peritoneal endometriosis in fertile age women.. Reproductive biomedicine online. https://doi.or¬g/10.1016/j.rbmo.2020.06.008.
