Ateşli İdrar Yolu Enfeksiyonu ile Başvuran Anorektal Malformasyonlu 8 Yaşında Kız Hasta
Özet
Bu vaka sunumunda, yenidoğan döneminde perineal fistüllü anorektal malformasyon (ARM) tanısı ile kolostomi açılıp sonradan kapatılan ve üç yıl önce gergin omurilik ameliyatı geçiren sekiz yaşındaki bir kız hastanın, ateşli idrar yolu enfeksiyonu (İYE) ve son dönemde başlayan idrar kaçırma şikayetleriyle başvurusu ele alınmaktadır. Hastaya yapılan tetkiklerde sol evre 1 hidronefroz ile sağ evre 1 ve sol evre 2-3 vezikoüreteral reflü (VUR) saptanmıştır. ARM, rektumun anal açıklık yerine perineuma veya ürogenital sisteme bir fistülle açılmasıyla karakterize konjenital anomalilerdir. Hastaların %20-54’ünde konjenital ürogenital anomaliler, %25’inde ise nörovezikal disfonksiyon gibi ciddi ürolojik problemler eşlik eder. Bu nedenle, ARM saptanan tüm hastaların doğumda ultrasonografi (USG) ile taranması; İYE veya kaçırma durumunda ise sistoüretrografi (İSUG), sintigrafi ve ürodinami gibi yöntemlerle detaylıca incelenmesi gerekmektedir. Sunulan hastada yapılan ürodinami sonrası mesane disfonksiyonu için antikolinerjik tedavisi ve kabızlık tedavisi başlanmış, takibinde reflünün gerilediği görülerek antibiyotik profilaksisi kesilmiştir. Bu olgu, ARM hastalarında gelişebilecek böbrek hasarı ve son dönem böbrek yetmezliği riskini en aza indirmek için multidisipliner takip ve erken müdahalenin önemini gözler önüne sermektedir.
This case presentation discusses the admission of an eight-year-old female patient—who underwent colostomy due to an anorectal malformation (ARM) with a perineal fistula in the newborn period that was subsequently closed, and who had tethered cord surgery three years ago—with complaints of febrile urinary tract infection (UTI) and recent urinary incontinence. Evaluation revealed left grade 1 hydronephrosis along with right grade 1 and left grade 2-3 vesicoureteral reflux (VUR). ARM is a group of congenital anomalies characterized by the rectum opening into the perineum or urogenital system via a fistula instead of a normal anal opening. Serious urological problems, such as congenital urogenital anomalies in 20-54% of patients and neurovesical dysfunction in 25%, often accompany this condition. Therefore, all patients diagnosed with ARM must be screened with ultrasonography (USG) at birth, and those with UTIs or incontinence should be evaluated in detail using methods like voiding cystourethrography (VCUG), scintigraphy, and urodynamics. In the presented patient, anticholinergic therapy for bladder dysfunction and treatment for constipation were initiated after urodynamics, and antibiotic prophylaxis was discontinued upon observing the resolution of reflux during follow-up. This case highlights the vital importance of multidisciplinary follow-up and early intervention to minimize the risk of renal damage and end-stage renal disease in patients with ARM.
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