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Adhesive Small Bowel Obstruksi

Date post: 07-Jul-2018
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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.


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