Intususepsi

Lebih penting dari hemoroid krn

banyak diartikan sbg disentri ,byk pd
bayi 6 bln bab berdarah
 Intussusception
• The Invagination or telescoping of a proximal
segment (septum)of bowel (usus masuk
kedalam usus) (intussusceptum) into the lumen
of a distal segment (intussuscipiens)
 Pathophysiology
• The invaginated segment is carried distally by
peristalsis.
• Mesentery and vessels become involved with the
intraluminal loop and are squeezed within the
engulfing segment causing venous congestion.
Mesetrium kalo masuk jd masalah lbh sulit
karena dia bawa darah
• Types: enteroenteric, enterocolic, and colocolic.
 Epidemiology (Children)
• Most common in infants and children
• Accounts for 95% of all cases of intussusception
• Ranks 2nd to appendicitis as a cause of acute
abdomen
• 90% of the cases in children are
idiopathic(penyebabnya tdk specifik)
• Most common in children of 6 months to 2 years
in age
 Epidemiology (Adults)
• Rare in adults: accounts for 0.003% to 0.02% of
all hospital admissions
• Accounts for 1% of all bowel obstructions in
adults
• 80-90% of cases have and underlying cause
• 65% are due to neoplasm
 Epidemiology
• Location
– Adults: ileoileal > ileocolic > colocolic
– Children: ileocolic > ileoileal > colocolic
 Etiology
• Idiopathic (most common in children)
• Neoplasm
– Benign (more common in small bowel)
• Polyp, Leiomyoma, Lipoma, Lymphoma, Adenoma of appendix, Appendiceal
stump granuloma

– Malignant
• Primary (more common in colon)
• Metastatic (more common in small bowel)
 Etiology(jarangg)
• Postoperative (more common in small bowel)
• Meckel’s diverticulum
• Colitis
• Many cases thought to be related to viral
gastroenteritis in children

• Kalo apendisitis demam ada ga terus demam dulu

atau nyeri dulu soalnya apendistis itu nyeri dulu,
biasa kalo nyeri di kanan bawah
 History and Physical
• Children:
– Well nourished infant
– Cramping abdominal pain
– Poor feeding / Vomiting
– Diarrhea (often currant-jelly stools)warna merah tua
kaya jelly ada berlendir, terapi disentrium amoeba
mtronidazole
– A palpable, tender, sausage shaped mass in the
abdomen
– Hx of abdominal surgery
 History and Physical
• Adults
– Intermittent pain
– Nausea and vomiting
– Often red blood per rectum
– Often nonspecific complaints
 Abdominal Studies
• Abdominal films often
show signs of small
bowel obstruction
 Abdominal Studies
• Erect films often show
fluid levels in the small
bowel
 Barium Studies
• Show a classic “coiled
spring” appearance due
to trapping of contrast
between layers of bowel.
 Ultrasound

• Ultrasound: transverse
scan shows a target sign

•
 CT (see-tee)
• Target sign is also seen in
CT.
• Can also see a sausage
shaped mass
 Imaging
• CT is the most accurate detecting 78% of the
cases.
• Ultrasound is often used in children
• Barium studies are also very useful
 Treatment (children)
• Air reduction is the treatment of choice for
children and is successful 75-90% of the time
• Contrast reduction was more frequently used a
decade ago

• Kebanyakan skrg dipake bukan barium tapi

udara
 Treatment (Adults)
• Adults require surgical exploration and resection of
the intussuscepted bowel loops
• Reduction is not recommended in adults due to the
risk of spreading/seeding malignant cells, potential
perforation of the intussuscepted bowel, and venous
embolization at the ulcerated mucosa area

• Kalo anak jgn dipotong lgsg tp di dorong pelan2, kalo

dewasa langsung operasi