ACUTE ABDOMEN

oleh:
Dr. Sigit Widodo, Sp. Rad

Bagian Radiologi
FK. Universitas Trisakti
Jakarta
2007

ACUTE ABDOMEN
Foto abdomen 3 posisi
(supine,LLD,setengah duduk)
I.1.Ileus USUS HALUS
1. Coiled Spring Appearance
2. Herring Bone Sign
3. Fluid level
4. Step Ladder Pattern

2.Ileus Usus Besar (Colon)

a.Ileocaecal Valve Competent
*Colon dilatasi
*Usus halus tidak ada kelainan
b.Ileocaecalvalve In-Competent
*Colon tidak disfensi
*Usus halus distensi
Volvulus sigmoid
*Distensi ahaustal
*Sigmoid ~U terbalik

II.PERFORASI
*Free air sickle
(SUBDIAPHRAGMA)
III.PERTITONITIS
1. Properitoneal fat hilang
2. Dinding usus halus > tebal

PNEUMOPERITONEUM

Pneumoperitoneum.Erect chest film.Free intra-abdominal

gas is clearly demonstrated under the right hemidiaphragm.
Under the left hemidiaphragm a small triangular collection of
the free gas can be identified between loops of gas-filled
bowel ( arrow)

PNEUMOPERITONEUM

Pneumoperitoneum. Abdomen supine, a triangular collection of free

gas is demonstrated in the subhepatic region (arrows).The falciform
ligament is also outline (arrowheads)

 Pneumoperitoneum.Abdomen supine.Visualization of both

sides of the bowel wall (Riglers sign).Both the inside and
outside wall multiple loops of small bowel can be identified
clearly

PERFORASI

1.
2.
3.

PENYEBAB :
Appendicitis
Typhoid Fever
Ulcus Pepticum
-Ulcus Ventriculi
-Ulcus Duodeni
GAMBARAN RADIOLOGI :
Pneumo Peritoneum (Udara / gas bebas)

Sigmoid volvulus

Sigmoid volvulus. Supine film.The hugely dilated ahaustral loop of

sigmoid can be seen rising out of the pelvis in the shape of an iverted
U. Haustrated ascending and descending colon can be identified
separate from the volved sigmoid loop

PARALYTIC ILEUS

Paralysis ileus. Supine film.There is generalized dilatation

of both small and large bowel. An 84-year-old woman with
generalized peritonitis perforation of gastric-ulcer

Large Bowel Obstruction

Large bowel obstruction. Type IA (competent ileocecal valve). Supine

film. There is gaseous distention of the large bowel from the sigmoid
backwards, including the ascending colon and caecum. The dilated
caecum lies in the pelvis. There is no visible small-bowel distention

OESOPHAGUS

MODALITAS PEMERIKSAAN RADIOLOGI

1. Radiologi Polos :
a.Thorax AP (Oesophagus)
Polos Abdomen (gaster, usus halus,
usus besar)
2. Radiografi Kontras (BARIUM)
Oesophagus. Gaster duodenum,usus halus,
usus besar
3. CT-Scan
4. USG (Hepar, Tr.Biliaris,Pancreas)

OESOPHAGUS
ANATOMI :
1. Phrenic ampula :
-Tepat di atas diaphragma
- Panjang : 3 5 cm, 2 4 cm
2. Cardiac Antrum = esophageal Vestibula
-Terletak Intra abdominal
- Bilia keluar di atas diaphragma Sliding
Hernia
3. Schatski Ring :Kontraksi Sphincter Oesophagi
Inferior

4. Penyempitan di 3 :
a.Setinggi Os.Cricoid
Corpus
b.Menyilang Bronchus kiri
Alienum
c.Masuk diaphragma
5. Vena:
a.Distal : V.Coronaria Ventriculi
V.Porta (Cir.Hepatis Varices)
b.Proximal : V.Azygos V.Cava Sup

Kelainan-kelainan pada
Oesophagus
1.
2.
3.

Kongenital
Radang
Tumor
Jinak
Ganas
4. Gangguan Neuromuskular
5. Sebab sebab lain : -Ulcus
-Varices

KONGENITAL
1.
2.
3.

Atresia Oesophagus
Stenosis Oesophagus
Divertikel
Additional Deffect
4. Double Oesophagus

ATRESSIA OESOPHAGUS
Radiograph demonstrating
a common type of
esophageal atresia in
association with a
tracheosophageal fistula.In
this instance the atressia
occurred in the middle
one-third sector of the
oesophagus
communicates with the
tracehobronchial tree near
its bifurcation

DIVERTIKEL

Radang Oesophagitis
Etiologi :
- Trauma (Indwelling Tube)
- Bakteri : TBC , Lues
- Jamur
- Rangsangan berulang Makanan Panas
Oesophagogram :
- Akut : (-)
- Kronis : Lumen sempit, mucosa irreguler

 PEPTIC
OESOPHAGITIS.
Comparisson of
normal mucosa
A.With severe ulcerative
peptic oesophagitis

TUMOR
1. Jinak
Polyp,Lipoma,Myoma
* Ro : FILLING DEFECT,Batas tegas
2. Ganas Carcinoma
*Ro :
Papillary : Filling Defect,batas tegas
Ulcerating : Filling Defect, di dalamnya additional
defect
Infiltrating : Lumen sempit,dinding irreguler

Tumor :
1. Jinak
2. Ganas
-Primer
-Sekunder

 TUMOR JINAK
Jenis : Adenoma
Polyp
Villous Papillomo
Hamartoma = Peuts Jager Syndrom
Ro : Filling Defect, batas tegas

SQUAMOUS CARCINOMA OF
THE OESOPHAGUS

a.Shallow ulcer with tumor rim

b.Small filling defect resembelling an intramural
lesion

Ca. Oesophagus

Carcinoma in the lower portion of the middle one-third of the oesophagus, in association
with dilatation above the level of the carcinoma,indicating partial obstruction
Carcinoma of the lower one-half of the oesophagus showing fistulous communication
with the mediastinum due to an invasion of the mediastinum by the carcinoma

ACHALASIA = MEGA OESOPHAGUS =

CARDIOSPASM
Spasme di hiatus
Obstruksi,dilatasi,elongasi,hipertrofi
oesophagus
Terjadi : setiap umur
Etiologi : ??
-Neuromuskular incordination
-Degenerasi plexus

 Ro :
Tapering bagian bawah oesophagus
obstruksi
Dilatasi bagian atas
Tipe : 1.Sigmoid
2.Fusiform

 Achalasia with typical tapered of the lower end of

the oesophagus producing obstruction. On
fluoroscopy the impaired motility will be evident.
Insufficient barium has entered the stomach to
distend it

Achalasia Oesophagus

Radiograph demonstrating the esophagus in achalasia.Note the fusiform

tapered distal end of the esophagus and the redudancy and dilatation of the
esophagus above this level
A spot film study of the lower esophagus in the same patient, showing the
tapered effect in greater detail

GANGGUAN NEUROMUSKULER
1. Spasme
Ro : Lumen sempit
Fluoroscopy : Peristaltik
2.Ripple oesophagus
Cork Screw / curling
Ro : - Saw tooth appearance
- Serrated
3.Achalasia ( Cardiospasm)

 SEBAB-SEBAB LAIN
1. Varices
*Etiologi : Cirrosis hepatis hipertensi portal
*RO : Mocosa terputus-putus:
a.Cincin halus ( Honey comb app)
b.Cincin kasar ( Cobble Stone app)
2.Ulcus oesophagi
*Ro : Additional defect
3.Hernia oesophagi

Varices Oesophagus
Spot film radiographic
studies of the lower
one-third of the
esophagus with
demonstration of
marked esophageal
varices
Esphagogram
demonstrating large
indicatins due to
esophageal varices

 Oesophageal
varices.Typical wormlike feeling defects
A.Non-distended
oesophagus following
passage of barium
B.Same case with
barium

PEMERIKSAAN GASTER
DAN DUODENUM (MD)
I.Polos : posisi tegak / supine
Untuk :
-stenosis pylorus
- Atressia duodeni
II.Kontrast
A.Single contrast
Barium sulfat ( 1 : 2-3 (air))
B.Double contrast
Barium sulfat (positif)
Udara
(negatif)
1.sonde / catheter
2.Tablet effervescent

Posisi :
Tegak
Supine
Prone
Foto :
1.Overail view
2.Spot
Persiapan : puasa 4-6 jam

Ruggal Pattern

Kelainan - Kelainan
I.KONGENITAL :
Hypertrophic pyloric obstruction
Atressia duodeni
II.RADANG :
Gastritis : atrophic
Chronica : Hypertrophic

III.TUMOR
1. Jinak (adenoma,fibroma,polip)
2. Ganas ( CA)
IV.ULCUS PEPTICUM
1. Ulcus ventriculi
2. Ulcus duodeni
V.LAIN-LAIN :
Prolaps pylorus
Volvulus

DUODENITIS
Radiograph
demonstrating the
widened, irregular
rugal pattern of the
duodenal bulb
associated with
duodenitis

GASTRITIS
DEFINISI :
Aneka ragam kondisi yang menimpa
mucosa,hanya sebagian karena radang
Kebingungan terjadi karena hubungan
yang tidak menentu antara klinis, radiologi,
endoskopi dan histologi, terutama yang
kronik

ACUTE GASTRITIS
Acute erosive (Hemoraghic) gastritis
karateristik : oedema dan erosi mucosa
Penyebab :
Stress, trauma, analgesic, steroid, alkohol,
virus, bile reflux
Klinis :
Sangat variasi : asimptomatik , dengan nyeri
perut, anorema, BB yang tidak dapat
diterangkan

 Radiologis :
1.Complete : target lesion / bulls eye lesion
Small central spot barium dikelilingi
Translucent halo
2.Incomplete : > sulit oleh karena tidak ada
translucent halo

CHRONIC GASTRITIS
1. CHRONIC ATROPHIC GASTRITIS
*Radiologis :
Area gastrica besar
Irrgular
Area tanpa area gastrica
*Diagnosis sensitif : endoskopi dan biopsi

2.CHRONIC HYPERTOPHIC GASTRITIS

Radiologis :
Mucosal fold thickening dan tortuosity
( Hyperugosity), Normal : sangat
variasi !!,>0,5 cm
Abnormal : antrum fundus, curvatura
major > 1,5 cm

Erosive Gastritis

A. Numerous erosions are present in the stomach, best seen in two rows in the antrum. Each
erosion consist of a small central collection of barium surrounded by transluccent ring ( a
small target lesion). By definition these are complete erosions. B. Prominent areae gastricae
with several small incomplete erosions (two of the erosions are indicated with arrows).

Antral Gastritis

A. Two thickened nodular mucosal folds are present (arrowed) and the antrum is conical. The mucosa in
the duodenal cap is also thickened (duodenitis). B. Severe antral gastritis. The normal antral mucosa
is replaced by a mass of thickened nodular mucosal folds. Conical narrowing of the antrum
completely obliterates the normal distal shoulders.

ULCUS PEPTICUM
Lokasi : 70% duodenum
30% gaster
Ulcus duodeni
Lokasi : 90 % bulbus
4 % Post Bulbar
1 % distal
: 75 %
: 25 %
Single : 80 %, Multiple : 20 %


1.
2.
3.

Ro :
Ulcus niche / crater terutama DD
posterior
Deformity bulbus
Mucosa : -Dasar ulcus duodenum
-Sekitar ulcus radiating

 Ulcus ventriculi
90 % dapat ditunjukkan Ro
Ro :
1. Ulcus niche / crater
2. Garis radiolucent pada dasar ulcus :
1-2 mm garis hampton
3. Barium fleck dengan jari-jari seperti roda pedati
= cart wheel
4. Kontralateral dari ulcus ada kontrast (incisura)

DD /

1.
2.
3.
4.
5.
6.
7.

Ulcus benigna
Cepat sembuh
Mucosa sekitar ulcus
reguler
Ulcus ventrikuli disertai
ulcus duodeni
Dalamnya > lebarnya
Tidak pernah di curvatura
major
Di sekitar ulcus
oedematous
Kontralateral : kontraksi

Ulcus maligna
Lama
Irreguler
Biasanya single
Lebarnya > dalamnya
Ulcus di curvatura major
selalu maligna
6. Di sekitar ulcus kaku
(rigid)
7. -
1.
2.
3.
4.
5.

Ulkus Gaster - Benign & Malignant

Comparison of benign and malignant lesser-curvature gastric ulcers. A. Benign ulcer projecting,
smooth base, radiating folds to ulcer brim. B. Malignant ulcer projecting (uncommon),
irregular base, absence of clearly defined ulcer brim, absence of radiating folds to brim, loss
of normal mucosal surface to area around ulcer.

Ulkus Gaster - Benign

Benign gaster ulcer on the greater curvature (sump ulcer). This ulcer is typical of
those occuring in patients who are taking tablets which produce contact iiritation
and damage to the gastric mucosa (e. g., nonsteroidal anti-inflammatory drugs,
steroid, potassium chloride).

Ulkus gaster

Radiograph illustrating incisura opposite a gastric

ulcer (Dark arrow, incisura : while arrow, lesser
curvature ulcer)

TUMOR GASTER
1.Benigna (Polip, papiloma, fibroma,adenoma)
2.Maligna ( carcinoma)
Poliposis :
Ro :
1. Filling defect,batas tegas
2. Mobile
3. Peristaltik masih baik
4. Bentuk lambung masih normal

CA Gaster
: = 3 : 1
Umur : 40 70 tahun
40 50 % Ca Traktus Gastro Intestinalis
Patologis
Exophytic : a.Fungating
b.Polipoid
2. Infiltrative
3. Ulceratif ( di bagian yang nekrotik)

1.

1.
2.
3.
4.

Lokasi : - 70% pylorus

- 20% corpus
- 8 % Cardia
Ro : Sangat bervariasi tergantung dari ukuran,
lokasi, morfologi
Filling defect : polipoid /
fungating,single/multiple
Infiltratif : dinding irreguler, rigid, peristaltik
lokal (-)
Ulcerasi
Infiltrasi yang luas gaster mengkerut + rigid
LINITIS PLASTICA

Gastric Carcinoma

Early gastric carcinoma: mixed types. A. An elevated tumour (between) the black arrowheads) is
outlined by barium. Two small irregular ulcers are present (white arrows). B. The Tumour
comprise a group of nodules and several small irregular areas of ulceration (arrowed). The
mucosal folds (on either side of the vertical white line) are amputated at their lower ends.

ATROPHIC GASTER

A.Relatively hypotonic stomach with thin-walled fundus and absent rugal

pattern in fundus,B.Smooth greater curvature and sluggish peristaltis,
C.Speckled appearance of the barium, suggesting flocculatin in gastric
mucosa,D.Crumpled paper appearance of the rugae near the
cardia,E.Bald,thin,speckled fundus with crumpled paper pattern also

USUS HALUS
Pemeriksaan :
1. Abdomen polos
2. Kontras : Ba Follow trough
I.Lanjutan Pemeriksaan lambung duodenum
- 2 gelas barium sekaligus
sebagian-sebagian
- Fluoroscopy : s/d Ileum terminalis
II.PEMERIKSAAN SENDIRI
Selang karet / plastik s/d pylorus masukkan
barium

Ba Follow Through
Tujuan:
1. Kelainan intriksik
2. Kelainan ekstrinsik
a.Dekat
Usus halus
b.Jauh

INDIKASI :
1. Anemia yang tidak diketahui kausa
2. Diare yang persisten
3. Nyeri abdomen
4. Mass abdomen yang palpabel
5. Gas dan cairan banyak di usus halus
6. Kehilangan protein yang banyak
7. Laboratoris : MALABSORBTION

KONTRAINDIKASI
1. Obstruksi usus
2. Perforasi usus
3. Ileus paralitik
4. Peritonitis
5. Infeksi akut saluran cerna

KELAINAN PADA USUS HALUS

1. Obstruksi ileus
2. Inflamasi kronik / granulomatosis
a.Crohns disease
b.TBC usus halus
3. Malabsorption syndrome
4. Tumor
5. Diverticle
6. Gangguan vaskuler
7. Penyakit endokrin (Zollinger Ellison Disease)
8. Penyakit penyakit parasit

CROHNS DISEASE = REGIONAL

ILEITIS = REGIONAL ENTERITIS
=
Semua umur,tersering 15-30 th.
Jarang < 4 th
Lokasi : 85 % di usus halus Ileum distal
Klinis :
Gejala obstruksi
Anemia dengan kausa ?
Occult Blood di feces
3. Malabsorbtion Syndrome

1.
2.

 Ro :
Fase akut :
Mucosa oedema dinding usus menebal
Cobble stone app
Lumen normal
Fase kronik :
Fibrosis obstruksi,dinding striktur,
kaku (rigid), gambaran mukosa (-)
Hose pipe app : lumen sempit,elongatio, skip area (ada
area yang sehat)
String sign
Scattering dan clumping

Crohns Disease

Crohns disease. The iiregular loops demonstrate an

ulceronoudular appearance

Crohns Disease

The follow-through shows scaterred areas of ulceration and

narrowing, with almost normal appearance in the terminal ileum

Crohns Disease

Numerous narrowed areas are seen, with fold thickening and

pseudosacculation on the antimesentric margin.

REGIONAL ENTERITIS
Coarsened rugal
pattern of the distal
ileum producing a
cobblestone
appearance.

REGIONAL ENTERITIS

Segmentation or clumping of the small intestines as found in a patient with regional

enteritis. It will also be noted, however, that there is a complete distruption of the normal
mucosal pattern with evidence of ulceration in the distal ileum
Scattering of barium in small intestines. This was a patient with regional enteritis, there is
evidence of distruption of mucosal pattern, some evidence of clumping, and loss of
normal mucosal pattern

REGIONAL ENTERITIS

A.Regional enteritis of the small intestine. Thhe white arrow points to a moulage sign,
whereas the dark arrow points to a fistulation between two loops of small
intestines.There is an additional fistula between the ileum and sigmoid colon.B,Regional
enteritis with the fistula formation between jejenum and sigmoid colon
Ulceration and sawtoothing in the distal ileum in a patient with regional enteritis

TUMOR USUS HALUS

Insidens : sangat jarang
Klasifikasi :
1.Jinak
2.Ganas
TUMOR JINAK
Jenis : Leiomyoma
Adenoma
Lipoma,hemangioma
Ro : Filling defect dengan batas tegas dan rata

TUMOR GANAS
1. Carcinoid
Ro :
Polypoid filling defect single / multiple
Mass filling defect
2. Adeno Ca
Ro :
Filling defect
Lumen irreguler
Dinding kaku
Khas kalsifikasi (PSAMOMA)

COLON

Panjang : 5 5,5 kaki (150-160 cm)

Diameter : 5 7,5 cm
Bagian :
Caecum
Colon ascendens
Colon transversum
Colon descendens
Colon sigmoid
Colon rectum

COLON INLOOP
= BARIUM INLOOP
= BARIUM ENEMA
Persiapan:
Harus baik colon bersih / kosong :
1. Makan bubur kecap 1 hari sebelumnya
2. 10 -12 jam sebelumnya : laxans garam
inggris ( 30 gr)
Dulcolax tab / supp
3. Puasa

 Kontras : Barium * Single contrast (SC)

* Double contrast (DC)
Single contrast :
Barium :
Bubuk : air = 1 : 4 ,hangat
-1L
Mengisi colon dengan gaya berat :
standard 1 meter ( tidak lebih) s/ d Ileum
terminalis

Double contrast
Teknis > sukar daripada single contrast
Tahapan :
Pengisian s/d Flexura Lienalis
Pelapisan : 1-2 menit
Pengosongan : miringkan (left decubitus) dan
tegakkan (Upright)
4. Pengembangan
5. Foto : spot view
overall view
Komplikasi : 1.Perforasi
2.Reflex vagal X sulfas atropin, 02

1.
2.
3.

COLON INLOOP DOUBLE

CONTRAST
1. Mengubah pola makanan : lunak, rendah
serat,rendah lemak
2. Minum sebanyak-banyaknya :
penyerapan air terbanyak di colon feces
lembek
3. Pencahar : usia lanjut, rawat baring lama,
sembelit kronik
4. Banyak bergerak, jangan merokok

FOTO COLON INLOOP

1. Plain = polos
2. Full filling : A.Spot
B.Overall
3. Post evakuasi

COLON INLOOP
INDIKASI :
1. Kongenital Hirschprungs
2. Inflamasi kronik
Diare persitent
Perdarahan per anum
3. Tumor
4. Obstruksi colon
Invaginasi
Volvulus

KONTRAINDIKASI :
1. Ileus paralitik
2. Perforasi usus / lambung
3. Obstruksi ileus yang lama (> 8 jam)
4. Peritonitis
5. Inflamasi akut G.I.T

COLON

Radiograph of the colon after evacuation of barium

KELAINAN KONGENITAL
I.ATRESSIA ANI = IMPERFORATE ANUS
Ro : posisi RICE WANGENSTEIN = pasien
dibalik : kepala di bawah,daerah anus diberi
marker ditentukan jarak (udara s/d marker)

ATRESIA RECTUM

Prone cross-table lateral view showing a high rectal atresia.

The arrow points to the uppermost air shadow and the site
of the atresia

II.Hirschprung disease = Megacolon

congenital
Insidens : anak-anak
:
Klinis : Obstipasi, perut kembung / besar
Ro : Penyempitan lumen yang aganglionik

HIRSCHPRUNG

Short-segment Hirschprungs disease. The distal narrowed segment is

arrowed

COLITIS
I.NON SPESIFIK
1. Colitis ulcerativa
2. Crohns disease
3. Ischamic colitis
II.SPESIFIK
Colitis TBC

COLITIS TBC

Lokasi :

1.Ileocecal ( 90%)
2.Kadang-kadang meluas
3.Appendix

Insidens :
- 30% atau lebih pada KP
- Jarang primer

1.
2.
3.
4.
5.
6.

Ro :
Teknik : 1.Barium follow through
2.Barium Enema
Tanda-tanda :
Hypermortility
Irregular ileocecal filling defect
Spasme Regio ileocecal
Plastic peritonitis
Segmentation,dilatation,stasis di ileal loops
STIERLINS SIGN :
Ileum dan colon transversum terisi barium,
tetapi caecum dan colon ascendens tidak terisi

COLITIS TBC

Tuberculosis. There is a short irregular stricture in

the ascending colon

COLITIS ULCERATIVA

Klinis : Umur 20-40 tahun, :

Patologi : infeksi akut ulcerasi mucosa,
dinding usus terkena difus fibrosis,
kontraksi

 Ro:
1. Haustra hiloang, spasme, irritability, saw tooth
Colon transversum
2. Post evakuasi : String sign = Hose pipe
3. Ulcer crater
4. Ileocecal terbuka (patent) , DD/TBC
5. Colon transversum : kontraksi,memendek dan
lumen menyempit
6. Caecum : kontraksi irreguler, mucosa MARBLE

COLITIS ULCERATIVA

A.B.Ulcerative colitis, showing a fine granularity throughout the colon,

which is shortened and totally devoid of haustration

COLITIS ULCERATIVA

Ulcerative colitis.Coarse granularity

COLITIS AMUBA
Lokasi : -Ileocaecal
-Colon ascendens
-Rectum sigmoid
Patologi : Ulcerasi fibrosis adhesi annular
Constriction
Ro:
Mula-mula (-)
Progress : segmenting haustra di cecum dan colon
ascendens cicatrix
Pemendekkan dan penyempitan
Saw tooth
Tidak patognomonis

CARCINOMA COLON
Lokasi : - kasus sigmoid, rectum,
recto sigmoid, jarang multiple
Patologi : Adeno Ca (50-75 %)
Fibro Ca (20%)
Metastasis : hepar, regional lymphnode
Ro :
1. Polypoid Bertangkai (Pedunculated)

 Ro :
1.Polypoid
Bertangkai (Pedunculated)
(23%)
Tidak bertangkai (sessile)
2.Fungating = apple score (asimetris)
3.Annular = napkin ring ( simetris)
(75%)

Carcinoma Colon

A large proliferative carcinoma of the ascending colon (arrows)

Carcinoma Colon

A classic annular carcinoma (arrow)

Ca Colon

DIVERTICULA COLON
:=2:1
Umur > 40 tahun
Lokasi : sigmoid, colon descendens
Keluhan : -Perdarahan
-Bila terinfeksi
Ro : ADDITIONAL DEFECT

VOLVULUS
DEFINISI : Mesenterium Colon berputar pada
axisnya Strangulasi (hambatan sirkulasi)
Lokasi : Sigmoid (75%)
Caecum
Predisposisi :
Sigmoid terlalu panjang
Fecal stasis
Megacolon
Insidens : : = 2 : 1
20 50 tahun

 Ro :
I.Polos :
1.Dilatasi colon
Ileus
2.Fluid level
Obstruksi
3.U terbalik di hipochondria
kiri
II.Colon inloop :
1. Barium stop
2. Dilatasi hebat colon proximal
3. Barium sebagian dapat melewati penyempitan
~ Kipas (fan Share)

VOLVULUS RECTA

Radiograph demonstrating volvulus of the cecum

INVAGINASI =
INTUSSUGCEPTION
DEFINISI :
Usus proximal masuk ke dalam usus distal
Proximal Intussusceptum
Distal Intussuspiens
TIPE :
1. Ileoileal
2. Ileocolic
3. Colocolic

 Insidens : anak-anak oleh karena

perubahan pola makanan : cair padat
Gejala :
Sakit perut mendadak sekitar pusat
Perdarahan peranum
Teraba massa di sekitar pusat
Diagnosis :Colon in loop (< 10 jam)
Kamar operasi
Juga untuk terapi

IRRITABLE COLON SYNDROME =

COLON SPASM

1.
2.
3.
4.
5.

Definisi : Spasm Colon

Etiologi :
Psikologis
Reflex
Keracunan (Pb)
Inflamasi lokal
Idiopatik

1.
2.
3.
4.

Lokasi : 1.Colon Descendens

2.Colon sigmoid
Ro :
Lumen sempit
Haustra hilang
Mucosa rata
Bila mengenai sebagian besar colon
Ribbon-Like Structure (~ Pita / pipa)

NECROSTISING ENTERO COLITIS

( NEC )
Sering terjadi pada bayi premature,yang
mengalami tambahan stress.
Ini berhubungan dengan respiratory
distress, passage umbilical catheter,
obstruksi intestinal (terutama penyakit
Hirschsprung)
atau
setelah
pembedahan.

Breast feeding tampaknya memberi

semacam proteksi, di duga stress
mengakibatkan ischaemi dinding usus
dengan mekanisme reflex.
Ini mengakibatkan necrosis mucosa
dan prolifersi organisme pathogen.
Biasanya permulaannya dalam 2-5
hari bayi menjadi sakit, muntahmuntah dan sering terjadi perdarahan
rectal serta distensi abdomen.

Foto polos abdomen menunjukkan

distensi
usus,
pada
fase
awal
terutama pada kwadran kanan bawah.
Kemudian
tampak
gelembunggelembung
di
caecumini
harus
dibedakan dengan meconium ileus.

Gambaran klinik dan umur dapat

membantu
untuk
membedakannya.
Kemudian timbul gas di dinding usus
dan
dapat
dikenal
sebagai
longitudinal translucent streaks atau
sebagai cincintransluency bila usus
terlihat end on.
NEC dapat menyerang setiap bagian
usus, tetapi terutama menyerang ileum
terminalis dan colon.

Dan gas dapat dilihat dengan jelas pada

dinding colon. Gambaran ini harus dibedakan
dengan garis properitonea fat. Diagnosis
yang pasti dapat dibuat pada stadium ini.
Gas dapat di lihat pada sistem portal, suatu
tanda kegawatan.
Tanda
tanda
kegawatan
lain
adalah
unchanging
loop,
karena
ini
meliputi
gangrene, ascites, oedema dinding abdomen
dan perforasi usus.
Yang tersebut terakhir ini dapat tanpa gejala
(asymptomatic)
maka
pada
prakteknya
dibuat foto supine dan lateral setiap 6 jam

Karena bahaya perforasi colon, maka

dihindari pemeriksaan dengan kontras
(colon inloop).
Sering terjadi stricture hanya setelah
3 - 4 minggu. Pada fase ini
pemeriksaan dengan kontrs perlu
dilakukan dan aman.
Harus diingat beberapa egen yang
sempit
dapat
di
sebabkan
oleh
temporary
spasm,
bukan
oleh

Terima Kasih
&
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