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Volvulus
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- 2. VOLVULUS Obstruksi yg disebabkanoleh terpelintirnya usus lebih dari 180 derajat dari axis mesenterium. 1-5% obstruksi usus besar Sigmoid ~ 65% Cecum ~25% ColonTransverse ~4% Splenic Flexure
- 3. 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
- 4. SIGMOID GAMBARAN KLINIK Nyeri perut,distension, tidak ada flatus atau gerakan usus Pemeriksaan : tympanitic abdomen, distension, tender ness ringan, Teraba massa
- 5. SIGMOID RADIOLOGI “Jeratan dibagian dalamlumen ” appearance Dilated sigmoid loop with limbs pointing towards the RLQ
- 6. SIGMOID RADIOLOGI “Coffee bean” appearance withthe 2 pelintiran loops dengan double komponen dinding central
- 7. SIGMOID BARIUM ENEMA • Kontraindikasipd pasien dgn free air on AXR, Gejala klinis peritonitis, / suspect nekrotik usus • Bird’s beak • Bisa dekompresi
- 8. 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
- 9. SIGMOID PENATALAKSANAAN • Reseksi yangterlambat dgn primer anastomosis Mortality rate 8% • Operative mortality berhubungan dgn viabilitas usus Viable 12% vs nonviable 53 % mortality
- 10. CAECUM • Parietal peritoneumtdk 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
- 11. CAECUM GAMBARAN KLINIK • abdominalpain, 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
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- 13. CAECUM RADIOLOGI • “comma” shaped •Convexity toward right and downward • BE - risk of perforation with getting air/contrast to right colon
- 14. CAECUM PENATALAKSANAAN • Decompression dgncolonoscope Kurang sukses dibandingkan dgn sigmoid volvulus • Emergency operation bila ada tan da masalah pembuluh darah
- 15. CAECUM • Detorsi ±appendectomy • Cecopexy/Laparoscopic cecopexy • Cecostomy • Resection Right colectomy with primary anastomosis
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