VOLVULUS

asdar tadjuddin
 VOLVULUS
Obstruksi yg disebabkan oleh terpelintirnya usus
lebih dari 180 derajat dari axis mesenterium.
1-5% obstruksi usus besar
Sigmoid ~ 65%
Cecum ~25%
ColonTransverse ~4%
Splenic Flexure
 SIGMOID
• Worldwide - up to 50% of obstruction
• Sering terjadi pd pasien yg tua.
• Redundant colon, mesocolon menyempit,
mesenterium terpelintir
• Faktor resiko
• Chronic constipation
• Masalah psikiatri
• Non-western societies
• high residue diet
 SIGMOID
GAMBARAN KLINIK
Nyeri perut, distension, tidak ada flatus atau gerakan
usus
Pemeriksaan : tympanitic abdomen, distension, tender
ness ringan, Teraba massa
 SIGMOID
RADIOLOGI
“Jeratan dibagian dalam lumen
” appearance
Dilated sigmoid loop with limbs
pointing towards the RLQ
 SIGMOID
RADIOLOGI
“Coffee bean” appearance
with the 2 pelintiran loops
dengan double komponen
dinding central
 SIGMOID
BARIUM ENEMA
• Kontraindikasi pd pasien dgn
free air on AXR, Gejala klinis
peritonitis, / suspect nekrotik
usus
• Bird’s beak
• Bisa dekompresi
 SIGMOID
PENATALAKSANAAN
Dekompresi Endoskopik
• Rigid / flexible proctosigmoidoscope dimasukkan ke rektum
• Gush of air/feces  successful decompression
• Rectal tube
• Successful in 85-90% of cases
• Kambuh > 60%
• Penurunan resiko nekrotik usus bila diobati dgn cepat
• Colon ischemia, perforation  Elective resection
 SIGMOID
PENATALAKSANAAN
• Reseksi yang terlambat dgn
primer anastomosis
Mortality rate 8%
• Operative mortality
berhubungan dgn viabilitas
usus
Viable 12% vs nonviable 53
% mortality
 CAECUM
• Parietal peritoneum tdk berhubungan dgn cecum & colon
kanan
• Ada sekitar 10 % of population
• Peningkatan mobilisasi usus, sehingga hal itu terpelintir pd
porosnya atau ke atas
• Pelintiran proximal ke cecum
• Faktor resiko:
Distal obstruction, Hamil, adhesions, jeratan congenital,
konstipasi lama, meteorism dgn tanpa tekanan udara
 CAECUM
GAMBARAN KLINIK
• abdominal pain, kolik
• Distention
• Type puntiran axial
• Puntiran 180-360 derajat pada longitudinal axis of co
lon assending (distal ileum and ascending colon)
• Berhubungan dengan bowel compromise, ischemia,
and perforation
• Cecal bascule
• Cecum folds anteriorly on ascending colon
• May result in intermittent obstructive symptoms
 CAECUM
GAMBARAN KLINIK
 CAECUM
RADIOLOGI
• “comma” shaped
• Convexity toward right and
downward
• BE - risk of perforation with
getting air/contrast to right
colon
 CAECUM
PENATALAKSANAAN
• Decompression dgn colonoscope
Kurang sukses dibandingkan dgn
sigmoid volvulus
• Emergency operation bila ada tan
da masalah pembuluh darah
 CAECUM
• Detorsi ± appendectomy
• Cecopexy/Laparoscopic
cecopexy
• Cecostomy
• Resection
Right colectomy with
primary anastomosis
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