ILEUS

Tutor : dr. Winoto Hardjolukito SpB

Epidemiology
Intra abdominal adhesions related to prior abdominal
surgery is the etiologic factor in up to 75 % of cases of
small bowel obstruction
Hernias and Crohn disease
Congenital Abnormalities
Schwartz s Manual of Surgery eighth edition. Chapter 27 Small Intestine Pg 706
Schwartz s Manual of Surgery eighth edition. Chapter 27 Small Intestine Pg 707
Pathophysiology
Intraluminal Intramural Extrinsic
Foreign bodies
Gallstone
Meconium
Tumors
Crohn disease
assosiated
inflamatory
strictures
Hematomas
Adhesions
Hernias
Carcinomatosis
Schwartz s Manual of Surgery eighth edition. Chapter 27 Small Intestine Pg 706-707
Obstruction
gas and uid accumulate
within the intestinal lumen
proximal to the site of
obstruction
microvascular
perfusion to the
intestine is
impaired
strangulating bowel
obstruction
intestinal ischemia,
and, ultimately,
necrosis.
the bowel distends and
intraluminal and intramural
pressures rise
Schwartz s Manual of Surgery eighth edition. Chapter 27 Small Intestine Pg 707
Clinical presentation
colicky abdominal pain
Nausea
Vomitus
Obstipation
Continued passage of atus and/or stool beyond
612 h after onset of symptoms is characteristic of
partial rather than complete obstruction
Symptom Sign
abdominal distention and hyperactive
bowel sounds
reect intravascular volume depletion and
consist of hemoconcentration and
electrolyte abnormalities
Mild leukocytosis is common

Features of strangulated obstruction include
tachycardia, localized abdominal
tenderness, fever, marked leukocytosis, and
acidosis
Schwartz s Manual of Surgery eighth edition. Chapter 27 Small Intestine Pg 707
Diagnostic
History prior abdominal operation
(suggesting the presence of adhesion)
The presence of abdominal disorders (intra
abdominal cancer or inflammatory bowel
disease)
On examination, search for hernias
(inguinal/femoral)
The stool should be checked for gross or
occult blood (intestinal strangulation)

Schwartz s Manual of Surgery eighth edition. Chapter 27 Small Intestine Pg 708
Diagnostic
The nding most specic
for small-bowel
obstruction is the triad of
dilated small-bowel loops
(>3 cm in diameter), air
uid levels seen on upright
lms, and a paucity of air
in the colon

Computed tomographic (CT)
scan ndings of small-bowel
obstruction include a discrete
transition zone with dilation of
bowel proximally,
decompression of bowel distally,
intraluminal contrast that does
not pass beyond the transition
zone, and a colon containing
little gas or uid
CT scanning also offers a global
evaluation of the abdomen and
may therefore reveal the
etiology of obstruction
X ray
CT Scan
Schwartz s Manual of Surgery eighth edition. Chapter 27 Small Intestine Pg 708
Therapy
uid resuscitation
bladder catheter is placed to
monitor urine output
pulmonary artery catheter
Broad-spectrum antibiotics
nasogastric (NG) tube
The operative
procedure performed
varies according to the
etiology of the
obstruction

The perioperative mortality rate associated with
surgery for nonstrangulating small-bowel
obstruction is less than 5 percent, with most
deaths occurring in older adult patients with
signicant comorbidities. Mortality rates
associated with surgery for strangulating
obstruction range from 825 percent.
Acute Paralytic Ileus
Current Medical Diagnosis and Treatment 2014. Gastrointestinal Disorders Pg 627
Ileus
paralitik
Ileus
obstruktif
Air fluid level
stepladder (anak
tangga)
Bising meningkat,
metalic sound
Perut kembung +
nyeri abdomen
Air fluid level line
up (segaris)
Bising usus lemah,
kadang tidak
terdengar
Perut kembung
Buku Ajar Ilmu Penyakit Dalam Bab 49 ileus paralitik hlm. 229