Ileus obstruktif adalah hambatan pasase usus akibat adanya sumbatan mekanik yang disebabkan adanya kelainan dalam

lumen usus

Ileus : the normal propulsion and passage of intestinal contents does not occur.
Obstructive : mechanical bowel obstruction
It is surgery case Caused by
Extrinsic : e.g. extraluminal tumor ( outside of bowel wall), volvulus of the sigmoid Intrinsic : e.g. Intraluminal tumor ( tumor of the bowel wall : colorectal cancer, Gastrointestinal stromal tumor of the ileum) Intraluminal : ascaris ball, corpus alienum
paralytic ileus due to electrolyte imbalance (hyponatremi, hypokalemi), hyperuremia pseudoobstruction at the large bowel ( Ogilvies Syndrome)
Maingot, Textbook of Abdominal Operation, 11th ed2006

Functional :

It is non surgery case, examples :

According to :

Grading of the obstruction : partial, total, strangulated Time : acute, chronic Location : high level ( small bowel ) and low level ( large bowel), generalized ( all of the bowel)

Symptoms of bowel obstructions

Signs of bowel obstructions

Obstipation Abdominal pain Abdominal distention lower GI tract Vomiting upper GI tract
Abdominal distention Visible bowel contour,visible bowel movement Increased bowel sound Metallic sound Collapsed rectal vault

Tidak bisa BAB/Flatus Kolik abdomen Distensi Mual/muntah

Riwayat operasi sebelumnya adhesi dalam perut Riwayat hernia Nyeri kolik (ileus obstruksi usus halus kolik dirasakan di sekitar umbilkus, sedangkan pada ileus obstruksi usus besar kolik di sekitar suprapubik. Muntah pada ileus obstruksi usus halus berwarna kehijauan dan pada ileus obstruktif usus besar onset muntah lama

Inspeksi
Tanda dehidrasi (turgor kulit menurun, mulut kering, lidah kering) Abdomen : distensi, darm contour (lekukan usus terlihat dari luar), darm steifung (gerakan usus terlihat dari luar) Benjolan pada regio inguinal, femoral, skrotal sugestif hernia inkarserata

Palpasi

Nyeri tekan abdomen Distensi abdomen Massa (curiga tumor) Perkusi

- Hipertimpani

Auskultasi
- Metallic sound - Bising usus meningkat

Ileus paralytic : decrease of sphincter ani tone Ileus obstructive : ampulla recti collapse

SIGNS OF BOWEL OBSTRUCTION + : High fever Persistent tachycardia despite rehydration

Peritonitis ( diffuse tenderness and rebound tenderness, muscular rigidity)

Foto polos abdomen

Posisi supine (terlentang) : herringbone appearance Posisi Left Lateral Decubitus : dilatasi usus proksimal obstruksi dan step ladder appearance, air fluid level Posisi setengah duduk/berdiri : air fluid level dan step ladder appearance

Maingot, Textbook of Abdominal Operation, 11th ed 2006

Greenle Hb et al, Arch Surg 108;470. 1974

Because the mesocolon is the longest

In child (9 month) from eat smooth food to rice

Megacolon is an abnormal dilation of the colon (a part of the large intestine). The dilation is often accompanied by a paralysis of the peristaltic movements of the bowel. Congenital / aganglionic megacolon Acquired

occur when there is protrusion of an internal organ into a retroperitoneal fossa or a foramen (congenital or acquired) in the abdominal cavity If a loop of bowel passes through the mesenteric defect, that loop is at risk for incarceration, strangulasi, or for becoming the lead point of a small bowel obstruction Obturator (through the obturator foramen) Howship-Romberg sign is suggestive of an obturator hernia, exacerbated by thigh extension, medial rotation and abduction.

Internal hernia winslow minor peritoneum cavum (the hole between duodenum, gaster, and hepatoduodenale ligament)

a cancer from uncontrolled cell growth in the colon or rectum (parts of the large intestine), or in the appendix. The classic warning signs include: worsening constipation, blood in the stool, decrease in stool calibre, loss of appetite, loss of weight, and nausea or vomiting in someone over 50 years old. Causes : IBD (Ulcerative colitis dan chrons disease), Genetics

Partial bowel obstruction : conservative treatment Non per oral ( fasting ) Abdominal decompression -> mencegah perforasi Rehydration, correction for electrolyte imbalance, Total Parenteral Nutrition Pasang NGT Antibiotics, Analgetics Close observation for 24-48 hours, if not resolvingtreated as total bowel obstruction When the obstruction has been resolved, consider contrast studies

Total bowel obstruction : suspect tumor or hernia as the cause, the definitive treatment is operation ( emergency exploratory laparotomy). The preparation before operation is the same as above ( conservative treatment ). Strangulated Bowel obstruction , Diffuse Peritonitis : Emergency exploratory laparotomy , The preparation before operation is the same as above ( conservative treatment ).

Absolut

Relatif

Peritonitis Perforasi visceral Hernia ireponibel Strangulasi

Percobaan konservatif

Massa yang teraba Tidak ada perbaikan terapi konservatif

Obstruksi parsial Adhesi Keganasan stadium lanjut Keraguan diagnostik

Peitzman AB, Rhodes M, Schwab CW, Yealy DM, Fabian TC; Lippincott Williams & Wilkins: The Trauma Manual; Trauma and Acute Care Sugery, 2008