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Illeus Obstruksi

A. DEFINISI

Obstruksi Illeus adalah gangguan aliran normal isi usus sepanjang saluran usus. Selvia A Price, Patologi)


B. ETIOLOGI

Penyebab terjadinya Obstruksi Illeus, antara lain :
  • Kondisi traumatic, terutama setelah fraktur iga dan fraktur tulang belakang.
  • Perlekatan karena pembedahan sebelumnya, sekitar 50 % terjadi pada usia pertengahan dan orang tua
  • Tumor ganas
  • Volvulus (usus yang terpelintir), paling sering terjadi pada pria tua dan biasanya mengenai kolon sigmoid
  • Hernia inguinalis atau femoralis
  • Benda asing, sering terjadi pada bayi dan anak
  • Kelainan konginetal.


C. TANDA DAN GEJALA

Gejala – gejala penting dari obstruksi Illeus adalah :
  • Nyeri daerah umbilicus
  • Muntah, sering terjadi bila obstruksi pada usus halus bagian atas
  • Konstipasi absolut dan peregangan abdomen.


D. PATOFISIOLOGI

Volvulus yang menjadi penyebab obstruksi illeus secara progesif akan teregang oleh cairan dan gas akibat peningkatan tekanan intralumen, yang menurunkan pengaliran air dan natrium dari lumen usus ke darah. Oleh karena sekitar 8 literr cairan diekskresi ke dalam saluran cerna setiap hari, tidak adanya absorbsi mengakibatkan penimbunan di intralumen dengan cepat. Muntah dan penyedotan usus setelah pengobatan dimulai merupakan sumber kehilangan utama cairan dan elektrolit.

Pengaruh atas kehilangan ini adalah penciutan ruang, cairan ekstrasel yang mengakibatkan syok-hipotensi, penurunan curah jantung, penurunan perfusi jaringan dan asiidosis metabolic. Peregangan usus yang terus menerus mengakibatkan penurunan absorbsi cairan dan peningkatan sekresi cairan ke dalam usus. Efek local peregangan usus adalah iskemia akibat distensi dan peningkatan permebialitas akibat nekrsosis, distensi absorbsi toksin-toksin bakteri ke dalam rongga peritoneum dan sirkulasi sistemik.



E. PEMERIKSAAN PENUNJANG
  1. Laboratorium
    Peningkatan kadar Haemoglobin (indikasi dari dehidrasi), leukositosis, peningkatan PCO2 / asidosis metabolik
  2. Rontgen abdomen
  3. Sigmoidescopy
  4. Colonoscopy
  5. Radiogram barium


F. PENATALAKSANAAN
  1. Koreksi keseimbangan cairan dan elektrolit
  2. Intubasi dan dekompresi untuk menghilangkan peregangan dan muntah
  3. Pembedahan
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