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P E M B I M B I N G :
D R . F E R R Y E R D A N I S P B K B D
ADHESIVE SMALL BOWELOBSTRUKSI
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PENDAHULUAN
• Ileus obstu!s" #$%& '"seb$b!$% $!"b$t $'(es" )$s*$o)e$s"'$)$t +e%"+bul!$% +ob"'"t$s '$% +ot$l"t$s #$%& *u!u)t"%&&"
• W$%"t$ , )"$ - $'(es" )$s*$ o)e$s" obstet"! '$%
&"%e!olo&"s • Pl"%& tese"%& "leus obstu!s" !$e%$ $'(es" )$s*$o)e$s"
te/$'" )$'$ usus ($lus
• Pe%el"t"$% etos)e!t"0 Me%1"es '$% Ell"s t$(u% 2334 te($'$)54 !$sus : A'(es" )$l"%& tese"%& 678-2t(% )$s*$ o)
928-26t(% )$s*$ o)
928-,24t(% )$s*$ o)
4.68-;2bl% )$s*$ o)
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ANATOMI
• Usus ($lus teb$&" $t$s t"&$ se&+e% #$"tu'uo'e%u+< /e/u%u+< '$% "leu+• Duo'e%u+ telet$! eto)e"to%el< '")"s$(!$% '$" '$"
&$ste ole( $'$%#$ )#lous '$" /e/u%u+ ole( b$t$sl"&$+e%tu+ Te"t1.
• =e/u%u+ '$% "leu+ telet$! '" "%t$)e"to%e$l '$%bet$+b$t !e eto)e"to%e$l +el$lu" +ese%te"u+
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• Usus ($lus '")e'$$(" ole( $te" +ese%te"!$su)e"o
• 'uo'e%u+ b$&"$% $t$s :
'")e'$$(" $te" )$%!eot"!o'uo'e%$l"s su)e"ob$&"$% b$>$( :
'")e'$$(" $te" )$%!eot"!o'uo'e%$l"s "%0e"o
• Ileu+ '")e'$$(" $te" "leo*ol"*$
•
Usus ($lus +e+)u%#$" 'u$ 0u%&s" ut$+$ #$"tu)e%*e%$$% '$% $bsobs" %ut"s"< $"< ele!tol"t '$%+"%e$l
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ADHESIVE SMALL BOWEL OBSTRUCTION (ASBO)
• De?%"s"
Obstu!s" usus -+e!$%"! $'$l$( !e$'$$% '"+$%$"s" lu+e% s$lu$% *e%$ t"'$! b"s$ '"s$lu!$% !e'"st$l $t$u $%us !$e%$ $'$ su+b$t$%@($+b$t$%
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ETIOLOGI
Obstu!s" +e!$%"! '$" lu+e% "%test"%$l b"$s$%#$'"seb$b!$% ole( t"&$ +e!$%"s+e
• blo!$'e "%t$lu+e% -obtu$s"• "%t$+u$l $t$u les" "%t"%s"! '$" '"%'"%& usus
• !o+)es" lu+e% $t$u !o%st"!s" $!"b$t les"e!st"%s"! '$" "%test"%$l.
2@ )$s"e% #$%& +e%&$l$+" "leus obstu!t"0<'"/u+)$" leb"( '$" s$tu 0$!to et"olo&" #$%&'"te+u!$% s$$t '"l$!u!$% o)e$s"
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Pe%#eb$b )$l"%& u+u+ '$" "leus obstu!s" $'$l$($'(es" )$s*$ o)e$s"< )e%#eb$b l$"%%#$ te+$su!
tu+o &$%$s -948
(e%"$ -248)e%#$!"t "%C$+$s" usus -68olulus -8)e%#eb$b l$"%l$"% -98
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PATOFISIOLOGI ADHESI
Teo" )$l"%& $>$l #$"tu $'$%#$ t$u+$ )$'$)e"to%eu+ +$!$ te/$'" )e%#e+bu($% se("%&&$
)$'$ $!("%#$ tebe%tu! $'(es"
Teo" se!$$%& !ese"+b$%&$% '"%$+"s $%t$$)e+be%tu!$% ?b"% '$% ?b"%ol#s"s. De%&$% !$'$
PAA -Plasminogen Activator Activity #$%& +e%uu%+$!$ !$'$ )l$s+"%o&e% +e%/$'" )l$s+"% $!$%+e%uu%< se("%&&$ +e%&$!"b$t!$% $!t""t$s?b"%ol"t"! +e%uu%
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KLASIFIKASI ADHESI PASA OPERASI
Be'$s$!$% +$!os!o)"s $'(es" )$s*$o)e$s" '"!l$s"?!$s"!$%seb$&$" be"!ut :
Grade I
A'$%#$ 'e)os"t ?b"%< t")"s se)et" be%$%& $t$u $'$%#$ $'(es"
$%t$ o&$% #$%&"%&$% '$% '$)$t '")"s$(!$% se*$$ tu+)ul
Grade II
A'$%#$ $'(es" #$%& '$)$t '")"s$(!$% se*$$ tu+)ul< t$)"seb$&"$% )elu '")"s$(!$% se*$$ t$/$+ 'e%&$% $s!ul$"s$s"
#$%& $)u(Grade III
V$s!ul$"s$s" /el$s< $'(es" *u!u) !u$t se("%&&$ ($us '")"s$(!$%se*$$ t$/$+
Grade IV
A'(es" !u$t< lu$s< ($us '")"s$(!$% se*$$ t$/$+ '$% !$e%$%#$
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• Be'$s$!$% ("stolo&"s< $'(es" )$s*$o)e$s" '"!l$s"?!$s"!$%
seb$&$" be"!ut :
Grade I
Te'$)$t bebe$)$ ?b"% '$% /$"%&$% "!$t #$%& s$%&$t e%&&$%&
'e%&$% se$t et"!ul"% #$%& s$%&$t $)u(Grade II
Te'$)$t /$"%&$% "!$t #$%& e%&&$%& +e%&$'u%& selsel '$%!$)"le!$)"le. Se$butse$but !oll$&e% '$)$t tel"($t.
Grade III
Stu!tu '$" /$"%&$% "!$t leb"( teb$l< te'$)$t )e%&u$%&$% /u+l$( '$" selsel< 'e%&$% )e%"%&!$t$% /u+l$( )e+bulu( '$$(<!$'$%&!$'$%& se$but "!$t el$st"! '$% otot )olos '$)$t'"te+u!$%
Grade IV
D"te+u!$% s!$ $t$u /$"%&$% !$llus #$%& leb"( +$tu< b"$s$%#$$"% $% $'(es" su'$( +e% $tu 'e% $% seos$ o $% sebel$(% $<
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DIAGNOSIS
Anamnesis dan Gejala Klinis Ileus Obstrusi Ad!esi
Pas"a#$erasi. %#e" )eut (eb$t "%te+"tte%t telo!$l"s".
. !e+bu%& t"'$! '$)$t BAB
. +u$l '$% +u%t$(.
. ">$#$t !o%st")$s" !o%"s
. )eub$($% bowel habit
Pemerisaan Fisi
. I%s)e!s" : darm contour '$% '$+ steifung
-. $us!ult$s" : b"s"%& usus $!$% +e%"%&!$t '$% b"$s$%#$$!$% te'e%&$ su$$ t"%&&" -metallic sound
. )$l)$s" $%&s$%& )e"to%e$l %#e" le)$s '$% defansmuskuler
-. *olo! 'ubu +e%"l$" !oll$)s t"'$!%#$ $+)ull$ e!t" '$%
%#e"
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E%aluasi A&al
'"$&%os"s "leus obstu!t"0 $'(es" -adhesive small bowel
obstruction $'$l$( 'e%&$% ray $b'o+e% )os"s" supine '$%erect #$%& +e%u%/u!$% &$+b$$% air uid level< '"ste%s" )$'$small bowel loop< '$% t"'$! $'$ u'$$ )$'$ *olo%
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E%aluasi Lanjutan
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TATALAKSANA• '#n O$erati
. %$so&$st"* tube 'e*o+)es"
. esus"t$s" *$"$% '$% !oe!s" ele!tol"t
• O$erati
. ASBO tet$) bet$($% '$l$+ ($" setel$('"l$!u!$% t$t$l$!s$%$ se*$$ %o% o)e$t"0
. olu+e '$"%$s" )$'$ ($" !et"&$ , 644 +l<leu!os"t , 26.444@++B
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K#m$liasi
2. G$%&&u$% !ese"+b$%&$% ele!tol"t '$% *$"$%
9. Is!e+"$ usus-)e"to%"t"s
. se)s"s
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PROGNOSIS
Mot$l"t$s obstu!s" t$%)$ st$%&ul$t$ $'$l$( 68s$+)$" 58.
Mot$l"t$s obtu!s" 'e%&$% st$%&ul$t$ s$+)$"
se!"t$ 68 $t$u 48.