ILEUS

OBTRUCTIO
N

Oleh : Intan Permata Sari

Pembimbing : dr. Gunawan, Sp. B
IDENTITAS PASIEN
Nama : Bpk. MS
Umur : 72 thn
Masuk RS tanggal : 17 Februari 2015
Alamat : Pundak, Bantul
Bangsal : Melati
Anamnesis
Os datang dengan keluhan perut terasa
kembung dan tidak nyaman sejak 1
minggu SMRS. Kadang disertai mual dan
muntah >5x/hari. Muntah beruapa
makanan dan terkadang berupa air liur
saja. Os juga mengeluh mengalami
gangguan BAB. Dalam sehari os bisa BAB
>3x namun konsistensinya sedikit sedikit.
Berwarna kuning dan tdk cair. Darah(-)
lendir (-).
Pemeriksaan Fisik
Vital Sign : TD : 170/80, S:36,8oC, RR: 18x,
N: 80x.
Pemeriksaan Fisik
Mata : Konjungtiva anemis (+/+) sklera
ikterik (-/-)
Mulut : Candidiasi (+)
Kulit : Turgor kulit >3, tampak kering.
Thoraks : SDV (+/+), S1 S2 reg (+)
RT : Teraba cengkraman (Striktur), tidak
terba benjolan. Darah (-), nanah(-)
Abdomen
Peristaltik
40x/menit
Hypertympani
Supel (-)
Distended (45 cm)
NT (-)
Peritonitis
No. ICPC II: D99 Disease digestive system,
other No. ICD X: K65.9 Peritonitis,
unspecified Tingkat Kemampuan: 3B
Tingkat Kemampuan 3:
mendiagnosis, melakukan
penatalaksanaan awal, dan merujuk
3A. Bukan gawat 3B.Gawat darurat
Fisiologi Percernaan
MECHANICAL ILEUS
 Definisi
Ileus adalah keadaan dari gerakan dan
pasase usus yang normal tidak terjadi. Ileus
timbul saat udara dan cairan sekresi tidak
dapat keluar kearah distal karena berbagai
sebab baik karena faktor intrinsik maupun
ekstrinsik (mechanical obstruction) atau
paralisis (non mechanical obstruction atau
pseudo ileus).

Helton WS, Fisichella PM. Intestinal Obstruction.Dalam : ACS Surgery : Principles

and Practices. 2004. WebMD Inc. Chapter 4 : 5-10
 KLASIFIKAS
I
Durati
Cause on Extent Type
Mechani Acute Partial Close
cal Chronic Complete loop
Function Simple
al
Mechanical Obstruction
Physical Blokage :
1. Intramural : congenital-tumor-hematoma-
inflammatory
2. Extramural : adhesion-volvulus-hernia
abscess-hematoma
3. Lumen obstruction: stone-meconium-
foreign body- impaction (stool-worm-
barium)
Penyebab
Pendarahan
& Obstruksi
Usus Halus
Etiologi
A. Small bowel obstruction:
1. Adhesion 60%
2. Hernia 20%
3. Neoplasm 5%
4. Volvulus 5%.
5. Others: IBD-GALL STONE-FOREIGN
BODY-INTUSSUSCEPTION.
B. Large bowel obstruction :
1. Cancer 60%.
2. Diverticular disease 15%.
3. Volvulus 15%.
4. Others: hernia fecal impaction-
inflammatory.
Lokasi
 PATOGENESIS
Distal Proksimal

Berdiltasi Perubahan
Kolaps Ekologi
- Penumpukan cairan
& gas
Pertumbuh
Air & elektrolit - Distensi Menyeluruh
byk
an kuman
dikeluarkan
Strangul Iskemik Translokas
asi i kuman
Syok Hipovolemik
Absorbsi
Perforasi
Toksin

Sepsis
DIAGNOSIS
HISTORY
- 4 Gejala Cardial Obstruksi (pain-vomiting-
distension and obstipation).
- Proximal obstruction earlier symptoms with
prominent vomiting and less distension. While
vomiting uncommon in colon obstruction till
late stage

EXAMINATION
o Vital signs.( PR-Temp-BP)
o Hydration status.
o Abdominal and rectal examinations
LABORATORY :
CBC: increase PCV (dehydration ) and increase in
WBC.
KFT: increase in BUN and creatinine .
Lactate concentration-amylase-lactic
dehydrogenase useful but not sensitive in
evaluations of bowel obstruction especially to rule
out necrosis
Serum concentration of phosphate--intestinal fatty
acid binding protein and isoforms of creatine
phosphokinase (isoform B): identify presence of
intestinal cell necrosis but the specificity and
sensitivity still note accurate.
ABG: metabolic and respiratory acidosis.
RADIOLOGI
Photo Polos Abdomen 3
posisi
Most Specific Finding: The Triad
1. Dilated small-bowel loops (>3 cm in
1.
diameter)
2. Air-Fluid levels on upright films
2.
3. Paucity of air in the colon.
3.

Sensitivity is 70 to 80%.
Small Bowel Gas
Pattern
Centrally located
Soft tissue across
entire lumen

Colon Gas Pattern

Peripheral Located
Mostly not
overlapping
Haustra markings
Treatment
A. Resuscitation.
A.
B. Conservative treatment
B.
1. Previous
1. Previous surgery.
surgery.
2. Incomplete
2. Incomplete obstruction.
obstruction.
3. Advanced
3. Advanced malignancy.
malignancy.
4. Uncertain
4. Uncertain diagnosis.
diagnosis.
C. Indications for surgery
C.
1. Generalized
1. Generalized oror localized
localized peritonitis.
peritonitis.
2. Perforation.
2. Perforation.
3. Irreducible
3. Irreducible hernia.
hernia.
4. Palpable
4. Palpable mass.
mass.
5. Virgin
5. Virgin abdomen.
abdomen.
6.
6. Closed
Closed loop
loop
7.
7. Failure
Failure to
to improve.
improve.
Penatalaksanaan
Small Bowel
Obstruction
menurut
Guideline for
Management of
Small Bowel
Obstruction 2008.
Terima Kasih