Professional Documents
Culture Documents
Referensi
1. Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia
and stenosis in : Aschraft Pediatric Surgery 3rd edition W.B. Saunders
Company. Philadelphia. Page 414 - 418
2. Applebaum, H. Sydorak, R. Chapter 81 Duodenal Atresia and
stenosis annular pancreas in : Coran Pediatric Surgery, 7th
edition.Philadelphia: Mosby Elsevier, 2006. page 1051-1057
General status
Kepala
Mata : anemis -/- , ikt -/- , Rp Isokor +/+ 2mm/2mm, reflek +/+
THT : napas cuping hidung +, sianosis
Mulut : Cyanosis
Leher : Pembesaran KGB Thorax: Pulmo: I : simetris
P : krepitasi -,
P : sonor +/+
A : vesikuler +/+, Rh -/-, Wh-/Cor
Abdomen:
Diagnosis :
Atresia Duodenum
ICD X
Q41.0 Congenital absence, atresia, and
stenosis of duodenum
Terapi :
Pediatri :
MRS
Kebutuhan cairan 80 ml/Kg/Hari
- IVFD D10% 150 ml/hari ~ 6 tpm
Ampicilin 2 x 100mg
Amikacin 15mg @ 18 jam
Aminofusin 2 x 5mg
Fototerpi 3 x 24 pi
Bedah Anak :
Duodenoduodenostomy
(Kimura procedure)
ICD IX
45.91 Duodenoduodenostomy
ATRESIA DUODENUM
SECUPLIK LANDASAN TEORI
ATRESIA DUODENUM
EPIDEMIOLOGI
Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft
Pediatric Surgery 3rd edition W.B. Saunders Company. Philadelphia. Page 414 - 418
Etiology
Intrinsik
Awal minggu ke -4 kehamilan duodenum mulai berkembang dari distal dan proximal
midgut.
Minggu ke 5-6 lumen duodenum tersumbat dan menyebabkan proliferasi sel epitel.
Minggu ke- 11 degenerasi sel epitel oleh karena vacuolation menyebabkan rekanalisasi
duodenum.
Ekstrinsik
Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft
Pediatric Surgery 3rd edition W.B. Saunders Company. Philadelphia. Page 414 - 418
KLASIFIKASI
Tipe I
90 % dari keseluruhan
obstruksi duodenum
Teradapat lumen
diafragma yang
mengandung lapisan
mukosa dan sub
mukosa
Windsock diafragma
nya melebar di bagian
distal
Tipe II
Dilatasi bagian
proksimal dan segmen
distal yang kolaps
terhubung dengan
fibrous cord
Tipe III
Terdapat Gap yang
jelas memisahkan
bagian distal dan
segmen distal
duodenum
1. Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft
Pediatric Surgery 3rd edition W.B. Saunders Company. Philadelphia. Page 414 418
2. Applebaum, H. Sydorak, R. Chapter 81 Duodenal Atresia and stenosis annular pancreas in :
Coran Pediatric Surgery, 7th edition.Philadelphia: Mosby Elsevier, 2006. page 1051-
Pembengkakan
Muntah
Tidak
Muntah
Hilangnya
Pemeriksaan Diagnostik
Pemeriksaaan Fisik
Inspeksi
Palpasi
PEMERIKSAAN DIAGNOSTIK
Radiograf
The
Tidak
Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft Pediatric Surgery
3rd edition W.B. Saunders Company. Philadelphia. Page 414 - 418
Lanjutannya
Sonography of the fetal abdomen (see pictures above), show 2 anechoic lesions
(double bubble sign). The first bubble is formed by the fluid filled fetal stomach,
the second being formed by the distended fetal duodenum. The obstruction is
likely to be at the 2nd part of the duodenum. These ultrasound images (double
bubble sign) suggest the likelihood of duodenal atresia.
PEMERIKSAAN DIAGNOSTIK
3. CT SCAN
4. MRI
Pictured (right) is a MRI of a
fetus with duodenal atresia. The
"double bubble" sign is indicated
with arrows. Increased amniotic
fluid also is seen, and it is
consistent with polyhydramnios
and intestinal obstruction.
I
Duodenal atresia in a 35-week-old fetus. Coronal single-shot fast spin-echo MR image shows
dilatation of the stomach (top arrow) and the proximal portion of the duodenum (bottom
arrow), producing a double bubble appearance
DIFFERENTIAL DIAGNOSIS
Pancreas Annulare
Hypertropic
Pyloric Stenosis
Malrotasi
Preduodenal
Portal Vein
PENATALAKSANAAN
Perioperatif
Management :
1. Nasogastric Decompression
2. Intravenous Hydration untuk :
- Koreksi balans cairan
- Elektrolit Imbalance
Walaupun merupakan Relatif Emergency namun tidak boleh tergesa2
dilakukan operasi sebelum Status Hemodinamik dan Elektrolit Stabil
Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft Pediatric
Surgery 3rd edition W.B. Saunders Company. Philadelphia. Page 414 - 418
INDIKASI PEMBEDAHAN
Secara
Duodenoduodenostomy
2
tehnik :
DIAMOND SHAPED
DUODENODUODENOSTOMY
1. Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in :
Aschraft Pediatric Surgery 3rd edition W.B. Saunders Company. Philadelphia. Page 414
418
2. Applebaum, H. Sydorak, R. Chapter 81 Duodenal Atresia and stenosis annular
Nellaton
cateter yang
kecil dimasukkan
melalui ujung segmen
distal yang dibuat.
20-30 ml saline
hangat diinjeksikan
Cateter kemudian
dilepas
Teknik lain
Subtotal duodenectomy and jejunal onlay patch procedure
Duodenojejunostomy
KOMPLIKASI
Intra
Opertive :
Identifikasi
Menyebabkan
Obstruksi
1. Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft Pediatric Surgery 3 rd edition W.B. Saunders
Company. Philadelphia. Page 414 418
2. Applebaum, H. Sydorak, R. Chapter 81 Duodenal Atresia and stenosis annular pancreas in : Coran Pediatric Surgery, 7 th
edition.Philadelphia: Mosby Elsevier, 2006. page 1051-1057
KOMPLIKASI
Postoperative
Keterlambatan
GERD
berat
Perdarahan
ulkus peptikum
Megaduodenum
Duodenogastric
Blind
reflux
loop syndrome
Obstruksi
1. Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft Pediatric Surgery 3 rd edition W.B. Saunders
Company. Philadelphia. Page 414 418
2. Applebaum, H. Sydorak, R. Chapter 81 Duodenal Atresia and stenosis annular pancreas in : Coran Pediatric Surgery, 7 th
edition.Philadelphia: Mosby Elsevier, 2006. page 1051-1057
OUTCOME
Mortalitas
3-5 %
Mortalitas terkait dengan prematuritas,
anomali organ lain, dan terminasi kehamilan.
Angka harapan hidup pada bayi dengan
obstruksi duodenum meningkat 45% - 95%
krn perbaikan dari segi penegakkan diagnosis,
teknik operasi dan perawatan pasca operasi
1. Aguayo,P. Ostlie, D.J Chapter 30 Duodenal and Intestinal Atresia and stenosis in : Aschraft Pediatric Surgery 3 rd edition W.B. Saunders
Company. Philadelphia. Page 414 418
2. Applebaum, H. Sydorak, R. Chapter 81 Duodenal Atresia and stenosis annular pancreas in : Coran Pediatric Surgery, 7 th
edition.Philadelphia: Mosby Elsevier, 2006. page 1051-1057
TERIMAKASIH