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ACUTE ABDOMEN

oleh:
Dr. Sigit Widodo, Sp. Rad


Bagian Radiologi
FK. Universitas Trisakti
J a k a r t a
2 0 0 7

ACUTE ABDOMEN
Foto abdomen 3 posisi
(supine,LLD,setengah duduk)
I.1.Ileus USUS HALUS
1. Coiled Spring Appearance
2. Herring Bone Sign
3. Fluid level
4. Step Ladder Pattern
2.Ileus Usus Besar (Colon)
a.Ileocaecal Valve Competent
*Colon dilatasi
*Usus halus tidak ada kelainan
b.Ileocaecalvalve In-Competent
*Colon tidak disfensi
*Usus halus distensi
Volvulus sigmoid
*Distensi ahaustal
*Sigmoid ~U terbalik
II.PERFORASI
*Free air sickle
(SUBDIAPHRAGMA)

III.PERTITONITIS
1. Properitoneal fat hilang
2. Dinding usus halus > tebal


PNEUMOPERITONEUM
Pneumoperitoneum.Erect chest film.Free intra-abdominal
gas is clearly demonstrated under the right
hemidiaphragm. Under the left hemidiaphragm a small
triangular collection of the free gas can be identified
between loops of gas-filled bowel ( arrow)
PNEUMOPERITONEUM
Pneumoperitoneum. Abdomen supine, a triangular collection of free
gas is demonstrated in the subhepatic region (arrows).The falciform
ligament is also outline (arrowheads)
Pneumoperitoneum.Abdomen supine.Visualization of both
sides of the bowel wall (Riglers sign).Both the inside and
outside wall multiple loops of small bowel can be identified
clearly
P E R F O R A S I
PENYEBAB :
1. Appendicitis
2. Typhoid Fever
3. Ulcus Pepticum
-Ulcus Ventriculi
-Ulcus Duodeni
GAMBARAN RADIOLOGI :
Pneumo Peritoneum (Udara / gas bebas)


Sigmoid volvulus
Sigmoid volvulus. Supine film.The hugely dilated ahaustral loop of
sigmoid can be seen rising out of the pelvis in the shape of an iverted
U. Haustrated ascending and descending colon can be identified
separate from the volved sigmoid loop
PARALYTIC ILEUS
Paralysis ileus. Supine film.There is generalized dilatation
of both small and large bowel. An 84-year-old woman with
generalized peritonitis perforation of gastric-ulcer
Large Bowel Obstruction
Large bowel obstruction. Type IA (competent ileocecal valve). Supine
film. There is gaseous distention of the large bowel from the sigmoid
backwards, including the ascending colon and caecum. The dilated
caecum lies in the pelvis. There is no visible small-bowel distention
O E S O P H A G U S
MODALITAS PEMERIKSAAN RADIOLOGI
1. Radiologi Polos :
a.Thorax AP (Oesophagus)
Polos Abdomen (gaster, usus halus,
usus besar)
2. Radiografi Kontras (BARIUM)
Oesophagus. Gaster duodenum,usus halus,
usus besar
3. CT-Scan
4. USG (Hepar, Tr.Biliaris,Pancreas)
O E S O P H A G U S
ANATOMI :
1. Phrenic ampula :
-Tepat di atas diaphragma
- Panjang : 3 5 cm, 2 4 cm
2. Cardiac Antrum = esophageal Vestibula
-Terletak Intra abdominal
- Bilia keluar di atas diaphragma Sliding
Hernia
3. Schatski Ring :Kontraksi Sphincter Oesophagi
Inferior
4. Penyempitan di 3 :
a.Setinggi Os.Cricoid Corpus
b.Menyilang Bronchus kiri Alienum
c.Masuk diaphragma
5. Vena:
a.Distal : V.Coronaria Ventriculi
V.Porta (Cir.Hepatis Varices)
b.Proximal : V.Azygos V.Cava Sup
Kelainan-kelainan pada
Oesophagus
1. Kongenital
2. Radang
3. Tumor Jinak
Ganas
4. Gangguan Neuromuskular
5. Sebab sebab lain : -Ulcus
-Varices
K O N G E N I T A L
1. Atresia Oesophagus
2. Stenosis Oesophagus
3. Divertikel
Additional Deffect
4. Double Oesophagus
ATRESSIA OESOPHAGUS
Radiograph demonstrating
a common type of
esophageal atresia in
association with a
tracheosophageal fistula.In
this instance the atressia
occurred in the middle
one-third sector of the
oesophagus
communicates with the
tracehobronchial tree near
its bifurcation
D I V E R T I K E L
Radang Oesophagitis
Etiologi :
- Trauma (Indwelling Tube)
- Bakteri : TBC , Lues
- Jamur
- Rangsangan berulang Makanan Panas
Oesophagogram :
- Akut : (-)
- Kronis : Lumen sempit, mucosa irreguler
PEPTIC
OESOPHAGITIS.
Comparisson of
normal mucosa
A.With severe ulcerative
peptic oesophagitis
T U M O R
1. Jinak
Polyp,Lipoma,Myoma
* Ro : FILLING DEFECT,Batas tegas
2. Ganas Carcinoma
*Ro :
Papillary : Filling Defect,batas tegas
Ulcerating : Filling Defect, di dalamnya additional
defect
Infiltrating : Lumen sempit,dinding irreguler

Tumor :
1. Jinak
2. Ganas
-Primer
-Sekunder


TUMOR JINAK
Jenis : Adenoma
Polyp
Villous Papillomo
Hamartoma = Peuts Jager Syndrom
Ro : Filling Defect, batas tegas

SQUAMOUS CARCINOMA OF
THE OESOPHAGUS
a.Shallow ulcer with tumor rim
b.Small filling defect resembelling an intramural
lesion
Ca. Oesophagus
Carcinoma in the lower portion of the middle one-third of the oesophagus, in association
with dilatation above the level of the carcinoma,indicating partial obstruction
Carcinoma of the lower one-half of the oesophagus showing fistulous communication
with the mediastinum due to an invasion of the mediastinum by the carcinoma
ACHALASIA = MEGA OESOPHAGUS =
CARDIOSPASM
Spasme di hiatus
Obstruksi,dilatasi,elongasi,hipertrofi
oesophagus
Terjadi : setiap umur
Etiologi : ??
-Neuromuskular incordination
-Degenerasi plexus
Ro :
Tapering bagian bawah oesophagus
obstruksi
Dilatasi bagian atas
Tipe : 1.Sigmoid
2.Fusiform
Achalasia with typical tapered of the lower end of
the oesophagus producing obstruction. On
fluoroscopy the impaired motility will be evident.
Insufficient barium has entered the stomach to
distend it
Achalasia Oesophagus
Radiograph demonstrating the esophagus in achalasia.Note the fusiform
tapered distal end of the esophagus and the redudancy and dilatation of the
esophagus above this level
A spot film study of the lower esophagus in the same patient, showing the
tapered effect in greater detail
GANGGUAN NEUROMUSKULER
1. Spasme
Ro : Lumen sempit
Fluoroscopy : Peristaltik
2.Ripple oesophagus
Cork Screw / curling
Ro : - Saw tooth appearance
- Serrated
3.Achalasia ( Cardiospasm)


SEBAB-SEBAB LAIN
1. Varices
*Etiologi : Cirrosis hepatis hipertensi portal
*RO : Mocosa terputus-putus:
a.Cincin halus ( Honey comb app)
b.Cincin kasar ( Cobble Stone app)
2.Ulcus oesophagi
*Ro : Additional defect
3.Hernia oesophagi

Varices Oesophagus
Spot film radiographic
studies of the lower
one-third of the
esophagus with
demonstration of
marked esophageal
varices
Esphagogram
demonstrating large
indicatins due to
esophageal varices
Oesophageal
varices.Typical worm-
like feeling defects
A.Non-distended
oesophagus following
passage of barium
B.Same case with
barium
PEMERIKSAAN GASTER
DAN DUODENUM (MD)
I.Polos : posisi tegak / supine
Untuk : -stenosis pylorus
- Atressia duodeni
II.Kontrast
A.Single contrast
Barium sulfat ( 1 : 2-3 (air))
B.Double contrast
Barium sulfat (positif)
Udara (negatif)
1.sonde / catheter
2.Tablet effervescent


Posisi :
Tegak
Supine
Prone
Foto :
1.Overail view
2.Spot
Persiapan : puasa 4-6 jam

Ruggal Pattern
Kelainan - Kelainan
I.KONGENITAL :
Hypertrophic pyloric obstruction
Atressia duodeni
II.RADANG :
Gastritis : atrophic
Chronica : Hypertrophic
III.TUMOR
1. Jinak (adenoma,fibroma,polip)
2. Ganas ( CA)
IV.ULCUS PEPTICUM
1. Ulcus ventriculi
2. Ulcus duodeni
V.LAIN-LAIN :
Prolaps pylorus
Volvulus


D U O D E N I T I S
Radiograph
demonstrating the
widened, irregular
rugal pattern of the
duodenal bulb
associated with
duodenitis
G A S T R I T I S
DEFINISI :
Aneka ragam kondisi yang menimpa
mucosa,hanya sebagian karena radang
Kebingungan terjadi karena hubungan yang
tidak menentu antara klinis, radiologi,
endoskopi dan histologi, terutama yang
kronik
ACUTE GASTRITIS
Acute erosive (Hemoraghic) gastritis
karateristik : oedema dan erosi mucosa
Penyebab :
Stress, trauma, analgesic, steroid, alkohol,
virus, bile reflux
Klinis :
Sangat variasi : asimptomatik , dengan nyeri
perut, anorema, BB yang tidak dapat
diterangkan



Radiologis :
1.Complete : target lesion / bulls eye lesion
Small central spot barium dikelilingi
Translucent halo
2.Incomplete : > sulit oleh karena tidak ada
translucent halo
CHRONIC GASTRITIS
1. CHRONIC ATROPHIC GASTRITIS
*Radiologis :
Area gastrica besar
Irrgular
Area tanpa area gastrica
*Diagnosis sensitif : endoskopi dan biopsi
2.CHRONIC HYPERTOPHIC GASTRITIS
Radiologis :
Mucosal fold thickening dan tortuosity (
Hyperugosity), Normal : sangat variasi
!!,>0,5 cm
Abnormal : antrum fundus, curvatura
major > 1,5 cm
Erosive Gastritis
A. Numerous erosions are present in the stomach, best seen in two rows in the antrum. Each
erosion consist of a small central collection of barium surrounded by transluccent ring ( a
small target lesion). By definition these are complete erosions. B. Prominent areae gastricae
with several small incomplete erosions (two of the erosions are indicated with arrows).
Antral Gastritis
A. Two thickened nodular mucosal folds are present (arrowed) and the antrum is conical. The
mucosa in the duodenal cap is also thickened (duodenitis). B. Severe antral gastritis. The
normal antral mucosa is replaced by a mass of thickened nodular mucosal folds. Conical
narrowing of the antrum completely obliterates the normal distal shoulders.

ULCUS PEPTICUM
Lokasi : 70% duodenum
30% gaster
Ulcus duodeni
Lokasi : 90 % bulbus
4 % Post Bulbar
1 % distal
: 75 %
: 25 %
Single : 80 %, Multiple : 20 %
Ro :
1. Ulcus niche / crater terutama DD
posterior
2. Deformity bulbus
3. Mucosa : -Dasar ulcus duodenum
-Sekitar ulcus radiating
Ulcus ventriculi
90 % dapat ditunjukkan Ro
Ro :
1. Ulcus niche / crater
2. Garis radiolucent pada dasar ulcus :
1-2 mm garis hampton
3. Barium fleck dengan jari-jari seperti roda pedati
= cart wheel
4. Kontralateral dari ulcus ada kontrast (incisura)
DD /
Ulcus benigna
1. Cepat sembuh
2. Mucosa sekitar ulcus
reguler
3. Ulcus ventrikuli disertai
ulcus duodeni
4. Dalamnya > lebarnya
5. Tidak pernah di curvatura
major
6. Di sekitar ulcus
oedematous
7. Kontralateral : kontraksi

Ulcus maligna
1. Lama
2. Irreguler
3. Biasanya single
4. Lebarnya > dalamnya
5. Ulcus di curvatura major
selalu maligna
6. Di sekitar ulcus kaku
(rigid)
7. --

Ulkus Gaster - Benign & Malignant
Comparison of benign and malignant lesser-curvature gastric ulcers. A. Benign ulcer projecting,
smooth base, radiating folds to ulcer brim. B. Malignant ulcer projecting (uncommon),
irregular base, absence of clearly defined ulcer brim, absence of radiating folds to brim, loss of
normal mucosal surface to area around ulcer.

Ulkus Gaster - Benign
Benign gaster ulcer on the greater curvature (sump ulcer). This ulcer is typical of
those occuring in patients who are taking tablets which produce contact iiritation
and damage to the gastric mucosa (e. g., nonsteroidal anti-inflammatory drugs,
steroid, potassium chloride).

Ulkus gaster
Radiograph illustrating incisura opposite a gastric
ulcer (Dark arrow, incisura : while arrow, lesser
curvature ulcer)
TUMOR GASTER
1.Benigna (Polip, papiloma, fibroma,adenoma)
2.Maligna ( carcinoma)
Poliposis :
Ro :
1. Filling defect,batas tegas
2. Mobile
3. Peristaltik masih baik
4. Bentuk lambung masih normal
CA Gaster
: = 3 : 1
Umur : 40 70 tahun
40 50 % Ca Traktus Gastro Intestinalis
Patologis
1. Exophytic : a.Fungating
b.Polipoid
2. Infiltrative
3. Ulceratif ( di bagian yang nekrotik)
Lokasi : - 70% pylorus
- 20% corpus
- 8 % Cardia
Ro : Sangat bervariasi tergantung dari ukuran,
lokasi, morfologi
1. Filling defect : polipoid /
fungating,single/multiple
2. Infiltratif : dinding irreguler, rigid, peristaltik
lokal (-)
3. Ulcerasi
4. Infiltrasi yang luas gaster mengkerut + rigid
LINITIS PLASTICA
Gastric Carcinoma
Early gastric carcinoma: mixed types. A. An elevated tumour (between) the black arrowheads) is
outlined by barium. Two small irregular ulcers are present (white arrows). B. The Tumour
comprise a group of nodules and several small irregular areas of ulceration (arrowed). The
mucosal folds (on either side of the vertical white line) are amputated at their lower ends.

ATROPHIC GASTER
A.Relatively hypotonic stomach with thin-walled fundus and absent rugal
pattern in fundus,B.Smooth greater curvature and sluggish peristaltis,
C.Speckled appearance of the barium, suggesting flocculatin in gastric
mucosa,D.Crumpled paper appearance of the rugae near the
cardia,E.Bald,thin,speckled fundus with crumpled paper pattern also
USUS HALUS
Pemeriksaan :
1. Abdomen polos
2. Kontras : Ba Follow trough
I.Lanjutan Pemeriksaan lambung duodenum
- 2 gelas barium sekaligus
sebagian-sebagian
- Fluoroscopy : s/d Ileum terminalis
II.PEMERIKSAAN SENDIRI
Selang karet / plastik s/d pylorus masukkan
barium

Ba Follow Through
Tujuan:
1. Kelainan intriksik
2. Kelainan ekstrinsik
a.Dekat Usus halus
b.Jauh
INDIKASI :
1. Anemia yang tidak diketahui kausa
2. Diare yang persisten
3. Nyeri abdomen
4. Mass abdomen yang palpabel
5. Gas dan cairan banyak di usus halus
6. Kehilangan protein yang banyak
7. Laboratoris : MALABSORBTION
KONTRAINDIKASI
1. Obstruksi usus
2. Perforasi usus
3. Ileus paralitik
4. Peritonitis
5. Infeksi akut saluran cerna
KELAINAN PADA USUS HALUS
1. Obstruksi ileus
2. Inflamasi kronik / granulomatosis
a.Crohns disease
b.TBC usus halus
3. Malabsorption syndrome
4. Tumor
5. Diverticle
6. Gangguan vaskuler
7. Penyakit endokrin (Zollinger Ellison Disease)
8. Penyakit penyakit parasit
CROHNS DISEASE = REGIONAL
ILEITIS = REGIONAL ENTERITIS
=
Semua umur,tersering 15-30 th.
Jarang < 4 th
Lokasi : 85 % di usus halus Ileum distal
Klinis :
1. Gejala obstruksi
2. Anemia dengan kausa ?
Occult Blood di feces
3. Malabsorbtion Syndrome
Ro :
Fase akut :
Mucosa oedema dinding usus menebal
Cobble stone app
Lumen normal
Fase kronik :
Fibrosis obstruksi,dinding striktur,
kaku (rigid), gambaran mukosa (-)
Hose pipe app : lumen sempit,elongatio, skip area (ada
area yang sehat)
String sign
Scattering dan clumping
Crohns Disease
Crohns disease. The iiregular loops demonstrate an
ulceronoudular appearance

Crohns Disease
The follow-through shows scaterred areas of ulceration and
narrowing, with almost normal appearance in the terminal ileum
Crohns Disease
Numerous narrowed areas are seen, with fold thickening and
pseudosacculation on the antimesentric margin.
REGIONAL ENTERITIS
Coarsened rugal
pattern of the distal
ileum producing a
cobblestone
appearance.
REGIONAL ENTERITIS
Segmentation or clumping of the small intestines as found in a patient with regional
enteritis. It will also be noted, however, that there is a complete distruption of the normal
mucosal pattern with evidence of ulceration in the distal ileum
Scattering of barium in small intestines. This was a patient with regional enteritis, there is
evidence of distruption of mucosal pattern, some evidence of clumping, and loss of
normal mucosal pattern
REGIONAL ENTERITIS
A.Regional enteritis of the small intestine. Thhe white arrow points to a moulage sign,
whereas the dark arrow points to a fistulation between two loops of small
intestines.There is an additional fistula between the ileum and sigmoid colon.B,Regional
enteritis with the fistula formation between jejenum and sigmoid colon
Ulceration and sawtoothing in the distal ileum in a patient with regional enteritis
TUMOR USUS HALUS
Insidens : sangat jarang
Klasifikasi : 1.Jinak
2.Ganas
TUMOR JINAK
Jenis : Leiomyoma
Adenoma
Lipoma,hemangioma
Ro : Filling defect dengan batas tegas dan rata
TUMOR GANAS
1. Carcinoid
Ro :
Polypoid filling defect single / multiple
Mass filling defect
2. Adeno Ca
Ro :
Filling defect
Lumen irreguler
Dinding kaku
Khas kalsifikasi (PSAMOMA)


C O L O N
Panjang : 5 5,5 kaki (150-160 cm)
Diameter : 5 7,5 cm
Bagian :
Caecum
Colon ascendens
Colon transversum
Colon descendens
Colon sigmoid
Colon rectum
COLON INLOOP
= BARIUM INLOOP
= BARIUM ENEMA
Persiapan:
Harus baik colon bersih / kosong :
1. Makan bubur kecap 1 hari sebelumnya
2. 10 -12 jam sebelumnya : laxans garam
inggris ( 30 gr)
Dulcolax tab / supp
3. Puasa
Kontras : Barium * Single contrast (SC)
* Double contrast (DC)
Single contrast :
Barium :
Bubuk : air = 1 : 4 ,hangat
- 1 L
Mengisi colon dengan gaya berat :
standard 1 meter ( tidak lebih) s/ d Ileum
terminalis
Double contrast
Teknis > sukar daripada single contrast
Tahapan :
1. Pengisian s/d Flexura Lienalis
2. Pelapisan : 1-2 menit
3. Pengosongan : miringkan (left decubitus) dan
tegakkan (Upright)
4. Pengembangan
5. Foto : spot view
overall view
Komplikasi : 1.Perforasi
2.Reflex vagal X sulfas atropin, 02
COLON INLOOP DOUBLE
CONTRAST
1. Mengubah pola makanan : lunak, rendah
serat,rendah lemak
2. Minum sebanyak-banyaknya :
penyerapan air terbanyak di colon feces
lembek
3. Pencahar : usia lanjut, rawat baring lama,
sembelit kronik
4. Banyak bergerak, jangan merokok
FOTO COLON INLOOP
1. Plain = polos
2. Full filling : A.Spot
B.Overall
3. Post evakuasi
COLON INLOOP
INDIKASI :
1. Kongenital Hirschprungs
2. Inflamasi kronik
Diare persitent
Perdarahan per anum
3. Tumor
4. Obstruksi colon
Invaginasi
Volvulus

KONTRAINDIKASI :
1. Ileus paralitik
2. Perforasi usus / lambung
3. Obstruksi ileus yang lama (> 8 jam)
4. Peritonitis
5. Inflamasi akut G.I.T
C O L O N
Radiograph of the colon after evacuation of barium
KELAINAN KONGENITAL
I.ATRESSIA ANI = IMPERFORATE ANUS
Ro : posisi RICE WANGENSTEIN = pasien
dibalik : kepala di bawah,daerah anus diberi
marker ditentukan jarak (udara s/d marker)
ATRESIA RECTUM
Prone cross-table lateral view showing a high rectal
atresia. The arrow points to the uppermost air shadow and
the site of the atresia
II.Hirschprung disease = Megacolon
congenital
Insidens : anak-anak
:
Klinis : Obstipasi, perut kembung / besar
Ro : Penyempitan lumen yang aganglionik


HIRSCHPRUNG
Short-segment Hirschprungs disease. The distal narrowed segment is
arrowed
C O L I T I S
I.NON SPESIFIK
1. Colitis ulcerativa
2. Crohns disease
3. Ischamic colitis

II.SPESIFIK
Colitis TBC
COLITIS TBC
Lokasi : 1.Ileocecal ( 90%)
2.Kadang-kadang meluas
3.Appendix
Insidens :
- 30% atau lebih pada KP
- Jarang primer

Ro :
Teknik : 1.Barium follow through
2.Barium Enema
Tanda-tanda :
1. Hypermortility
2. Irregular ileocecal filling defect
3. Spasme Regio ileocecal
4. Plastic peritonitis
5. Segmentation,dilatation,stasis di ileal loops
6. STIERLINS SIGN :
Ileum dan colon transversum terisi barium,
tetapi caecum dan colon ascendens tidak terisi

COLITIS TBC
Tuberculosis. There is a short irregular stricture in
the ascending colon
COLITIS ULCERATIVA
Klinis : Umur 20-40 tahun, :
Patologi : infeksi akut ulcerasi mucosa,
dinding usus terkena difus fibrosis,
kontraksi
Ro:
1. Haustra hiloang, spasme, irritability, saw tooth
Colon transversum
2. Post evakuasi : String sign = Hose pipe
3. Ulcer crater
4. Ileocecal terbuka (patent) , DD/TBC
5. Colon transversum : kontraksi,memendek dan
lumen menyempit
6. Caecum : kontraksi irreguler, mucosa MARBLE
COLITIS ULCERATIVA
A.B.Ulcerative colitis, showing a fine granularity throughout the colon,
which is shortened and totally devoid of haustration
COLITIS ULCERATIVA
Ulcerative colitis.Coarse granularity
COLITIS AMUBA
Lokasi : -Ileocaecal
-Colon ascendens
-Rectum sigmoid
Patologi : Ulcerasi fibrosis adhesi annular
Constriction
Ro:
Mula-mula (-)
Progress : segmenting haustra di cecum dan colon
ascendens cicatrix
Pemendekkan dan penyempitan
Saw tooth
Tidak patognomonis
CARCINOMA COLON
Lokasi : - kasus sigmoid, rectum,
recto sigmoid, jarang multiple
Patologi : Adeno Ca (50-75 %)
Fibro Ca (20%)
Metastasis : hepar, regional lymphnode
Ro :
1. Polypoid Bertangkai (Pedunculated)

Ro :
1.Polypoid Bertangkai (Pedunculated)
(23%) Tidak bertangkai (sessile)
2.Fungating = apple score (asimetris)
3.Annular = napkin ring ( simetris)
(75%)

Carcinoma Colon
A large proliferative carcinoma of the ascending colon (arrows)
Carcinoma Colon
A classic annular carcinoma (arrow)
Ca Colon
DIVERTICULA COLON
: = 2 : 1
Umur > 40 tahun
Lokasi : sigmoid, colon descendens
Keluhan : -Perdarahan
-Bila terinfeksi
Ro : ADDITIONAL DEFECT
VOLVULUS
DEFINISI : Mesenterium Colon berputar pada
axisnya Strangulasi (hambatan sirkulasi)
Lokasi : Sigmoid (75%)
Caecum
Predisposisi :
Sigmoid terlalu panjang
Fecal stasis
Megacolon
Insidens : : = 2 : 1
20 50 tahun
Ro :
I.Polos : 1.Dilatasi colon
Ileus 2.Fluid level
Obstruksi 3.U terbalik di hipochondria
kiri
II.Colon inloop :
1. Barium stop
2. Dilatasi hebat colon proximal
3. Barium sebagian dapat melewati penyempitan
~ Kipas (fan Share)
VOLVULUS RECTA
Radiograph demonstrating volvulus of the cecum
INVAGINASI =
INTUSSUGCEPTION
DEFINISI :
Usus proximal masuk ke dalam usus distal
Proximal Intussusceptum
Distal Intussuspiens
TIPE :
1. Ileoileal
2. Ileocolic
3. Colocolic
Insidens : anak-anak oleh karena
perubahan pola makanan : cair padat
Gejala :
Sakit perut mendadak sekitar pusat
Perdarahan peranum
Teraba massa di sekitar pusat
Diagnosis :Colon in loop (< 10 jam)
Kamar operasi
Juga untuk terapi


IRRITABLE COLON SYNDROME =
COLON SPASM
Definisi : Spasm Colon
Etiologi :
1. Psikologis
2. Reflex
3. Keracunan (Pb)
4. Inflamasi lokal
5. Idiopatik

Lokasi : 1.Colon Descendens
2.Colon sigmoid
Ro :
1. Lumen sempit
2. Haustra hilang
3. Mucosa rata
4. Bila mengenai sebagian besar colon
Ribbon-Like Structure (~ Pita / pipa)
NECROSTISING ENTERO COLITIS
( NEC )

Sering terjadi pada bayi premature,yang
mengalami tambahan stress.

Ini berhubungan dengan respiratory distress,
passage umbilical catheter, obstruksi intestinal
(terutama penyakit Hirschsprung) atau setelah
pembedahan.
Breast feeding tampaknya memberi semacam
proteksi, di duga stress mengakibatkan
ischaemi dinding usus dengan mekanisme
reflex.

Ini mengakibatkan necrosis mucosa dan
prolifersi organisme pathogen.

Biasanya permulaannya dalam 2-5 hari bayi
menjadi sakit, muntah-muntah dan sering
terjadi perdarahan rectal serta distensi
abdomen.
Foto polos abdomen menunjukkan distensi
usus, pada fase awal terutama pada kwadran
kanan bawah.

Kemudian tampak gelembung-gelembung di
caecumini harus dibedakan dengan
meconium ileus.


Gambaran klinik dan umur dapat membantu
untuk membedakannya. Kemudian timbul gas
di dinding usus dan dapat dikenal sebagai
longitudinal translucent streaks atau sebagai
cincintransluency bila usus terlihat end on.

NEC dapat menyerang setiap bagian usus,
tetapi terutama menyerang ileum terminalis
dan colon.
Dan gas dapat dilihat dengan jelas pada dinding
colon. Gambaran ini harus dibedakan dengan garis
properitonea fat. Diagnosis yang pasti dapat dibuat
pada stadium ini. Gas dapat di lihat pada sistem
portal, suatu tanda kegawatan.

Tanda tanda kegawatan lain adalah unchanging loop,
karena ini meliputi gangrene, ascites, oedema dinding
abdomen dan perforasi usus.

Yang tersebut terakhir ini dapat tanpa gejala
(asymptomatic) maka pada prakteknya dibuat foto
supine dan lateral setiap 6 jam pada fase akut.
Karena bahaya perforasi colon, maka dihindari
pemeriksaan dengan kontras (colon inloop).

Sering terjadi stricture hanya setelah
3 - 4 minggu. Pada fase ini pemeriksaan
dengan kontrs perlu dilakukan dan aman.

Harus diingat beberapa egen yang sempit
dapat di sebabkan oleh temporary spasm,
bukan oleh permanent firous stricture.
Terima Kasih
&
Selamat Belajar