1. Perforated peptic ulcer or gastric perforation occurs when there is a hole or discontinuity in the wall or membrane of an organ. 2. The most common causes of gastric perforation are peptic ulcers (60%) and blunt abdominal trauma (20-20%). 3. Clinical manifestations include sudden and severe abdominal pain localized to the epigastrium, which can be accompanied by vomiting, nausea, abdominal distension and fever. Diagnosis is confirmed through physical examination findings, imaging studies showing free air or fluid in the abdomen, and laboratory tests. 4. Treatment involves resuscitation, intravenous antibiotics, surgery to repair the perforation, and postoperative care. Complications can include

1. Perforasi Gaster
Oleh:Ahmad Rizzqi ,MD
1

2. Pendahuluan
2
Thorsen dkk. 2013. Epidemiology of Perforated Peptic Ulcer: Age and Gender Adjusted Analysis of Incidence and Mortality.
World Journal of Gastroenterology.
Aboobakar dkk. 2017. Gastric Perforation Following Blunt Abdominal Trauma. Elsevier Journal: Trauma Case Report.

3. Anatomi Gaster
3 Brunicardi F. C. dkk. 2010. Schwartz’s Principles of Surgery. Tenth Edition.

4. Fisiologi Gaster
4 Brunicardi F. C. dkk. 2010. Schwartz’s Principles of Surgery. Tenth Edition.
Sherwood, L. 2011. Fisiologi Manusia: Dari Sel ke Sistem. Edisi 11. Jakarta: EGC.

5. 5 Sherwood, L. 2011. Fisiologi Manusia: Dari Sel ke Sistem. Edisi 11. Jakarta: EGC.

6. Definisi dan Epidemiologi
6
60%
20%
20%
Perforasi gaster adalah adanya lubang atau diskontinuitas pada dinding atau membran
sebuah organ.
40-60
tahun
Bertleff dkk. 2011. Perforated Peptic Ulcer Disease: A Review of History and Treatment. Perforated Peptic Ulcers: New Insights.
Thorsen dkk. 2013. Epidemiology of Perforated Peptic Ulcer: Age and Gender Adjusted Analysis of Incidence and Mortality.
Aboobakar dkk. 2017. Gastric Perforation Following Blunt Abdominal Trauma. Elsevier Journal: Trauma Case Report.

7. Etiologi
7 Sjamsuhidajat, R., Karnadiahardja, W., Prasetyono, T. O. H., dan Rudiman, R. 2003. Buku Ajar Ilmu Bedah. Edisi ke – 2. EGC: Jakarta

8. Patogenesis-Ulkus Peptik
8 Soreide dkk. 2015. Perforated Peptic Ulcer. Lancet Journal.

9. Patogenesis-Trauma Tumpul Abdomen
 Mekanisme trauma:
 Kompresi eksternal akibat kenaikan tekanan intra-abdomen
secara akut dan intens.
 Deselerasi cepat.
 Benturan organ intraabdomen terhadap dinding perut anterior,
kolumna vertebral atau dinding torakalis posterior.
 Lokasi paling umum:
 Dinding anterior (60%)
 Kurvatura mayor (23%)
 Kurvatura minor dan dinding posterior (15%)
9 Aboobakar dkk. 2017. Gastric Perforation Following Blunt Abdominal Trauma. Elsevier Journal: Trauma Case Report.

10. Patogenesis
10 Aboobakar dkk. 2017. Gastric Perforation Following Blunt Abdominal Trauma. Elsevier Journal: Trauma Case Report.
Coup de Poignard

11. Manifestasi Klinis
11 Chung dkk. 2017. Perforated Peptic Ulcer-An Update. World Journal of Gastrointestinal Surgery.

12. Diagnosis
12
KU: Nyeri perut yang tajam
Lokasi : Epigastrium, seluruh lapang perut
Onset : Tiba-tiba
Sifat : Tajam, hebat
Intensitas : Terus menerus, atau terdapat periode
tidak nyeri dalam 1-2 jam onset nyeri pertama
Kejadian sebelum dan saat serangan
Keluhan lain: muntah cair/darah, mual, perut terasa
kembung, demam
RPD:
 Riwayat nyeri perut intermiten
 Riwayat refluks gastroesophageal
 Riwayat penyakit ulkus peptik
 Riwayat trauma atau operasi
RPO: NSAID
Anamnesis
Pemeriksaan
Penunjang
Pemeriksaan Fisik
Chung dkk. 2017. Perforated Peptic Ulcer-An Update. World Journal of Gastrointestinal Surgery.

13. Diagnosis
13
Anamnesis
Pemeriksaan
Penunjang
Pemeriksaan Fisik
 Status Generalis
 Takikardi
 Tanda-tanda syok
 Status Lokalis
 I : Distended, jejas
 A : Bising usus dapat bervariasi
 Pal: Defans muskular, nyeri tekan perut
dengan rigiditas
 Per: Dapat bervariasi
Chung dkk. 2017. Perforated Peptic Ulcer-An Update. World Journal of Gastrointestinal Surgery.

14. Diagnosis
14
Anamnesis
Pemeriksaan
Penunjang
Pemeriksaan Fisik
Chung dkk. 2017. Perforated Peptic Ulcer-An Update. World Journal of Gastrointestinal Surgery.
Diagnostic Peritoneal Lavage
CT Scan: akurasi 98%
Cairan intraperitoneal yang tidak dapat dijelaskan,
pneumoperitoneum, penebalan dinding usus, goresan
lemak mesenterika, hematoma mesenterika dan
ekstravasasi kontras.
Focused Assesment by Sonography for Trauma
Foto rontgen abdomen:
Rigler’s sign, football sign
Foto rontgen toraks posisi tegak:
Gambaran udara di bawah di bawah diafragma
Laboratorium

15. Penatalaksanaan
15 Aboobakar dkk. 2017. Gastric Perforation Following Blunt Abdominal Trauma. Elsevier Journal: Trauma Case Report.
Chung dkk. 2017. Perforated Peptic Ulcer-An Update. World Journal of Gastrointestinal Surgery.

16. Komplikasi Post Operatif
16 Bertleff dkk. 2011. Perforated Peptic Ulcer Disease: A Review of History and Treatment.
Perforated Peptic Ulcers: New Insights.

17. Prognosis
17 Thorsen, K., dan Soreide, J. 2014. What Is the Best Predictor of Mortality ini Perforated Peptic Ulcer Disease.
Gastrointestinal Surgery Journal.

18. TERIMAKASIH
18