Pemeriksaan Foto Polos Abdomen Ileus

Obstruktif dan Ileus Paralitik

BAGIAN RADIOLOGI FK UMI - MEDAN
dr . Irene Damanik Sp. Rad ( K) RA
MODALITAS PEMERIKSAAN
RADIOLOGI
X- RAY
X-RAY CONTRAST
COMPUTED TOMOGRAPHY
NUCLEAR MEDICINE
ULTRASOUND
MAGNETIC RESONANCE
PET
Foto Polos Abdomen

Posisi :
 AP / SUPINE
 PA ERECT
 LLD
Anatomi
Persiapan AP

 Patients should be changed into a hospital gown,

with radiopaque items removed (e.g. belts, zippers,
buttons)
 Patient is supine, lying on his or her back, either on
the x-ray table (preferred).
 The x-ray is taken on full inspiration
Penilaian

 The diaphragm should be included superiorly

 The abdomen should be free from rotation with
symmetry of the:
 ribs (superior)
 iliac crests (middle)
 obturator foramen (inferior)
 No blurring of the bowel gas due to respiratory motion
Indikasi
 Kasus akut abdomen, tergantung pada
pertanyaan klinis yang diajukan.
 (bowel obstructions, calcifications dan
neoplastic/ mass ).
Persiapan PA Erect
 The patient standing, and the X-rays travel from
anterior to posterior (horizontal beam).
 This view may be particularly helpful to look for
free intra-abdominal air (under the diaphragms)
and air-fluid levels.
Penilaian

 The diaphragm should be included superiorly

 The abdomen should be free from rotation with
symmetry of the:
 ribs (superior)
 iliac crests (middle)
 obturator foramen (inferior)
 No blurring of the bowel gas due to respiratory motion
Indikasi
 Visualizing gas-fluid levels and free gas in the
abdominal cavity as it allows the assessment of
ascites, perforation, intra-abdominal masses, ileus,
or postoperative complications.
Persiapan LLD ( Left Lateral
Decubitus)

 Patients should be changed into a hospital gown,

with radiopaque items (e.g. belts, zippers)
removed
 The patient is lying on either the left (left lateral
decubitus) or right (right lateral decubitus) side the
left lateral decubitus is preferred as any free
intraperitoneal gas will be contrasted by the liver
 x-ray is taken in full inspiration
Penilaian

 The diaphragm should be included superiorly

 The abdomen should be free from rotation with
symmetry of the:
 ribs (superior)
 iliac crests (middle)
 obturator foramen (inferior)
 No blurring of the bowel gas due to respiratory motion
Indikasi
 Identify free intraperitoneal gas
(pneumoperitoneum).
 The most useful position for detecting free
intraperitoneal air is the left lateral decubitus
position.
Ileus
 Ileus adalah gangguan/hambat an
pasase i s i usus yang me rupakan
 tanda adanya obstruksi usus akut yang
segera membutuhkan pertolongan atau
 tindakan. Ileus ada 2 macam yaitu ileus
obstruktif dan ileus paralitik
Ileus osbtruktif
 Disebut juga ileus mekanik.
 Karena adanya sumbatan atau hambatan mekanik
pada isi lumen saluran cerna tidak dapat disalurkan
ke distal .
 Disebabkan kelainan dalam lumen usus, dinding usus
atau luar usus yang menekan atau kelainan
vaskularisasi pada suatu segmen usus yang
menyebabkan nekrose segmen usus tersebut.
Etiologi
Gambaran radiologi
Ileus Paralitik
 disebut juga ileus adimanik
 Keadaan dimana usus gagal/ tidak
mampu melakukan kontraksi peristaltik
untuk menyalurkan isinya akibat
kegagalan neurogenik atau hilangnya
 peristaltik usus tanpa adanya obstruksi
mekanik.
Kasus Ileus obstruktif

Foto Polos Abdomen AP /

Supine
 Distribusi udara usus
meningkat
 Dilatasi dan distensi
bowel
 Gambaran coiled spring
dan herring bone.
 Prepertonel fat line
 Psoas line kanan kiri
 Free air ?
Foto Polos Abdomen PA
Erect :
 Distribusi udara usus
meningkat
 Dilatasi dan distensi bowel
 Multipel air fluid level
( step ladder pattern).
 Gambaran coiled spring
dan herring bone.
 Prepertonel fat line
 Psoas line kanan kiri
 Free air ?
 Foto Polos Abdomen
PA Erect :
 Gambaran cupula sign
pada subdiafragma
kanan  free air.
 Bedakan dengan udara
gaster pada
subdiafragma kiri.
Foto Polos Abdomen LLD :
 Distribusi udara usus
meningkat
 Dilatasi dan distensi bowel
 Multipel air fluid level
( step ladder pattern).
 Gambaran coiled spring
dan herring bone.
 Prepertonel fat line
 Psoas line kanan kiri
 Free air ?
LLD

Foto Polos
Abdomen LLD :
 Distribusi udara
usus meningkat
 Dilatasi dan
distensi bowel
 Multipel air fluid
level
 Free air (+)
Paralytic ileus

Called functional bowel obstruction : interruption of

the normal passage of bowel contents due to reduced
peristalsis in the absence of a mechanical obstruction.

It is often transient. Postoperation is one of the most

common causes of paralytic ileus

Other etiologies include inflammation of abdominal,

pelvic, or retroperitoneal.
Ileus paralitik
 Findings

 Diffuse small and large bowel gaseous distention

without transition or cutoff point
 The sentinel loop sign may be seen in localized
paralytic ileus
 Visible gas shadows in the rectum
 Free air if bowel is perforated (rare); note that
intraabdominal free air is expected after recent
abdominal surgery.
Kasus ileus paralitik
 Radiographs
show: (A) diffuse
distension of the
colon and small
intestine. (B)
dilated small and
large bowel
loops.
This radiograph shows
dilatation of the entire
colon, Paralytic ileus often
involves the entire small and
large bowel.
Potential causes of paralytic
ileus include : peritonitis,
recent surgery, sepsis, head
injury, some drugs and
metabolic disorders
Ileus paralitik
X-ray abdomen (AP view;
supine)

Gaseous distentions of the

small bowel loops and
prominent valvulae
conniventes are visible. Gas can
be seen within the stomach,
the large bowel, and the
rectum.
Ascites Gall stone
Perubahan letak organ sclerotic bone os pelvic
Thank you