Gastrik iskemi ve nekroz

Özet

Gastrik iskemi nadirdir; midenin zengin kollateral kanlanmasına rağmen şok, damar tıkanıklığı, volvulus veya aşırı distansiyon zemininde gelişebilir. Kontrastlı BT duvar perfüzyonunu, intramural gazı, portal venöz gazı, mide distansiyonunu ve çölyak/SMA dallarını aynı incelemede değerlendirmeye yardım eder. Azalmış duvar kontrastlanması ve pnömatozis, özellikle sistemik hastalık bulgularıyla birlikteyse nekroz olasılığını artırır; ancak intramural gaz tek başına geri dönüşsüz iskemi kanıtı değildir. Tanının gecikmesi mide nekrozu, perforasyon ve sepsisle sonuçlanabilir. Gastrik duvar içi gaz, özellikle portal venöz gaz eşlik ettiğinde, BT görünümüne dayanarak tek başına nekroz olarak yorumlanmamalı; klinik bağlamla birlikte değerlendirilmelidir.

Faz ve pencere

Kontrastsız

Mide duvarı içindeki gazın lümen gazından ayrılması, duvar içi spontan hiperdens kan ve damar kalsifikasyonlarının görülmesi için kullanılır; tek başına duvar canlılığını göstermez.

Arteriyel tanısal

Duvarın fokal veya yaygın azalmış kontrastlanması ile çölyak trunkus ve gastrik/pankreatikoduodenal arter dallarında tıkanma ya da akım azalması araştırılır; damar değerlendirmesi gerektiğinde arteriyel BT anjiyografi tanısaldır.

Portal tanısal

Duvar kontrastlanma kusurunun devamlılığı, ödem/kalınlaşma, çevresel sıvı, intramural gaz, portal veya mezenterik venöz gaz ve eşlik eden organ/bağırsak perfüzyonu değerlendirilir.

BT bulguları

• Normal duvar segmentine göre belirgin azalmış ya da kaybolmuş gastrik duvar kontrastlanması
• İskemik ödemle kalınlaşmış duvar veya ileri nekrozda incelmiş, düzensiz duvar konturu
• Duvar içinde lineer ya da kabarcıklı gaz odakları (gastrik pnömatozis)
• İntrahepatik portal dallarda veya splenik/mezenterik venlerde dallanan gaz
• Mide çevresinde serbest sıvı, yağ dokuda inflamasyon veya ekstralüminal gaz
• Belirgin gastrik distansiyon, çıkış obstrüksiyonu ya da organoaksiyel/mezenterikoaksiyel volvulus
• Çölyak trunkus darlığı veya tıkanıklığında SMA'dan gelişen kollateral akımı değerlendirin.
• Gastrik pnömatozis tek başına nekroz tanısı koydurmaz; intramural gazı klinik bulgularla birlikte yorumlayın.

Normalde

Mide duvarını değerlendirirken yeterli gastrik distansiyon sağlayın.

Ayırıcı tanı

Gastrik amfizem

kusma, sondalama veya distansiyon sonrası düzgün/lineer duvar gazı; duvar kontrastlanması korunabilir

Amfizematöz gastrit

duvar kalınlaşması ve düzensiz/çizgisel intramural gaz, inflamasyon ve sistemik toksisite ile birlikte olabilir

Mide intramural hematomu

kontrastsız seride duvar içinde hiperdens kan; antikoagülasyon veya travma öyküsü yardımcıdır

Gastrik volvulus

genişlemiş ve yer değiştirmiş mide, geçiş noktası ve anormal antral/pilorik konum

Peptik gastrit

mukozal hiper-kontrastlanma ve ödem; belirgin duvar perfüzyon kaybı veya damar tıkanıklığı beklenmez

Tuzaklar

• Portal venöz gaz ve gastrik pnömatozis benign kusma ilişkili gastrik amfizemde de görülebilir; bu ikiliyi tek başına nekroz tanısı sayma, duvar kontrastlanmasını ve klinik ağırlığı birlikte tart.
• Mide lümenindeki hava ile duvar gazı karışabilir; çok düzlemli kesitlerde gazın duvar içinde kaldığını ve lümenle devamlılığını incele.
• Kontrast zamanlaması zayıfsa bütün mide az kontrastlanmış görünebilir; aort ve diğer visseral organların opasifikasyonunu kontrol etmeden fokal iskemi çıkarımı yapma.
• Volvulus kaynaklı venöz tıkanma, arterler açık görünürken de duvar perfüzyonunu bozabilir; mide eksenini, geçiş noktasını ve duvarı birlikte değerlendir.

Kendini dene

1. Yakın zamanda şiddetli kusma sonrası stabil hastada mide duvarında ve portal venöz dallarda gaz görülmesi, peritonit yokluğunda gastrik amfizemle uyumlu olabilir. En olası benign açıklama hangisidir?

   • Gastrik amfizem
   • Mide nekrozu
   • Gastrik volvulus
   • İntramural hematom
   Cevabı göster

   Gastrik amfizem. Gastrik amfizem, enfeksiyöz olmayan intramural mide gazı nedenidir. Portal venöz gaz eşlik edebilse de, stabil klinik tablo ve peritonit bulunmaması gastrik amfizemle uyumludur.

2. Gaz oluşturan mikroorganizmaların neden olduğu ve yüksek mortaliteyle ilişkili intramural mide gazı tablosu hangisidir?

   • Gastrik amfizem
   • Amfizematöz gastrit
   • Gastrik volvulus
   • İntramural hematom
   Cevabı göster

   Amfizematöz gastrit. Amfizematöz gastrit, gaz oluşturan mikroorganizmaların neden olduğu ve yüksek mortaliteyle ilişkili bir mide duvarı enfeksiyonudur. Gastrik amfizem (GE) genellikle benign ve enfeksiyöz olmayan intramural gaz tablosudur; amfizematöz gastrit (EG) ise gaz oluşturan mikroorganizmaların neden olduğu ve yüksek mortalite taşıyan enfeksiyondur.

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.