lapsus stenosis ani.doc
TRANSCRIPT
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BAGIAN ILMU BEDAH CASE PRESENTATION
FAKULTAS KEDOKTERAN NOVEMBER 2013
UNIVERSITAS HASANUDDIN
STENOSIS ANI
OLEH :
NUR NAJWA SARONI
C11109777
PEMBIMBING :
d! "USFITARIA ALVINA
SUPERVISOR :
P#$ d! FARID NUR MANTU% S&!B% S&!BA
DIPRESENTASIKAN DALAM RANGKA
TUGAS KEPANITERAAN KLINIK BAGIAN ILMU BEDAH
FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN
2013
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LEMBAR PENGESAHAN
"'() *+,'(d','()'( d-*'.'/ -(- +(',''( *'/.' :
N'' : N N'4.' S'#(-
NIM : C 11109777
F'5,'6 : K+d#,+'(
U(-+6-,'6 : U(-+6-,'6 H'6'(dd-(
Jd5 C'6+ : Stenosis Ani
T+5'/ +(+5+6'-'( ,)'6 d'5' '()' +&'(-,+''( 5-(- &'d' B')-'( I5
B+d'/ F'5,'6 K+d#,+'( U(-+6-,'6 H'6'(dd-(!
M''66'% N#+*+ 2013
2
P+*-*-()%
d! "6$-,'-' A5-('
M+()+,'/-%
S&+-6# B')-'( I5 B+d'/
S*d--6- B+d'/ A('
P#$ d! F'-d N M'(,% S&!B% S&!BA
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LAPORAN KASUS
I. IDENTITAS PASIEN
N'' : B S
U : 23 /'-
J+(-6 K+5'-( : L'-85'-
N#! RM : 32;1
A5'', : D6( B+#&&' K'*! L.
R'()'( : NICU K'' 2B
T'())'5 MRS : 12 < 10 < 2013
II. ANAMNESIS : A55#'('(+6-6 =I* &+(d+-,'>
• K+5/'( U,'' : P+, +*+6'
• A('(+6-6 T+&-&-( :
D-'5'- 6+4' 6-' 7 /'- 6+,+5'/ +5'/-'(! M(,'/ 'd'% $++(6- 1 '5-%
,-d' +(+&#,% -6- ?'-'( *+.'(' (-()! R-.'', 6+-() (,'/
6+4' 6-' 7 /'-! A(' '5'6 +(+,+! B'() '- *+6' 6+d--,86+d--,%
#(6-6,+(6- +(?+! A(' ,-d' &+('/ +('()-6 6'', *'() '- *+6'! T-d'
&+('/ $+6+6 *+?'& d''/! R-.'', '(' 6+)+' *'() '- *+6'
+#(- 6+,+5'/ 5'/-% *+.'(' /-4' +/-,''(! K+(?-() ,-d' &+('/
+5' d'- 5*'() &'(,',! F+6+6 ,-d' &+('/ *+?'& '- +(?-()! '('
,-d' &+('/ +.+5 6'', *'() '- +?-5! B'() '- +?-5 5'(?'% .'('
(-()! T-d' 'd' )','58)','5 d- d'+'/ +'5'(! R-.'', #&+'6-
6+*+5(' ,-d' 'd'! R-.'', &+())(''( 5'6',-$ ,-d' 'd'! P++4''(
''/ &+,'(- d'( -* ,-d' *++4'!
R-.'', +5'/-'( : B'- 5'/- ?& *5'( = 29 -()) >% 5'/- 6&#(,'(
d-,#5#() d(% 5'()6() +('()-6% *+', *'d'( 5'/- 3% )!
R-.'', +/'-5'( : I* ,-d' &+('/ ,+4',/% ,-d' &+('/ d+'% ,-d'
,++(' 'd-'6- ',' ,+'&- 'd-'6-% ,-d' &+('/ +()#(66- 4'
6+5'' +/'-5'(! )-@- -* *'- d'( /'(' -( -,'-( '()
d-+6+&'( d#,+ 6+5'' +/'-5'(! U6-' 6'', /'-5 2 ,'/(! G;P;A0
3
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III. PEMERIKSAAN FISIK :
Status present : S'-, 6+d'() < G-@- ?& < C# +(,-6
Tana !ita" :
N'd- : 120< +(-,
P+('&'6'( : <+(-,
S/ : 3%90 C
Kepa"a :
K#(4(),-' : A(+-6 =8>% -(4+6-# =8>
S5+' : I,+6 =8>
B-*- : T-d' 'd' 6-'(#6-6
G6- : P+d''/'( =8>
Le#er :
K+5+(4' )+,'/ *+(-() : T-d' ,+d'&', &+*+6''(
DVS : R82 ?H20
M'66' ,# : T-d' 'd'
N+- ,+'( : T-d' 'd'
A$o%en :
I(6&+6- : D-6,+(d+d =>% -, )+' ('&'6%
d' ?#(,# =8>% d' 6,+-$() =8>
A65,'6- : P+-6,'5,- => +6'( +(-()',
;
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P'5&'6- : M'66' ,# =8>% (+- ,+'( =8>
P+6- : H-&+,-&'(-
R+?,'5 ,#?/+ :6$-(),+ +(?+-% '('5-6 '('5 6+&-, =4'-
+5-()-() d'&', d-'6'(>% '&5' ,-d' #5'&6%
#6' 5-?-(! M'66' ,# ,-d' 'd'! ! H'(d6?/#+( :
d''/ =8> 5+(d- =8> $+6+6 =>
T#ora&s :
I(6&+6- : S-+,-6 -- d'( '('(
P'5&'6- : N+- ,+'( =8>% '66' ,# =8>
P+6- : S#(# '('( --
A65,'6- : B(- &+('&'6'( : *#(#+6-5+
B(- ,'*'/'( : R#(/- 8<8% W/++@-() 8<8
I'. DIAGNOSIS
S,+(#6-6 '(- d+'4', -()'(
'. PENATALAKSANAAN A(AL
8 IVFD d+,#6+ 10 ?? < 4'
8 N,-6- +(,+'5 : 66 30 ??
8 A&-?-55-( 30 ) < )BB< 4'
8 G+(,'-?-( ; ) < )BB< 2; 4'
8 B6-('6- d+()'( d-5',# H+)' = *+/'6-5 6'&'- (#!13>
'I. HASIL PEMERIKSAAN
•
Pe%eri&saan La$oratoriu%:
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• pe%eri&saan USG a$o%en )*+),+*,)-
I(,+&+,'6-
8 T'&' d-5','6- d'( +?/# d'' '() *'(' &'d' )'6,+ d'( 5##&8
5##& 66!
8 H+&' : +?/# &'+(- (#'5% ,-d' ,'&' d-5','6- '65+% *-5+
d?, -(,' d'( 5+6- &',#5#)- 5'-(('
8 GB : d'5' *','6 (#'5
8 P'(+'6 : 65-, d- -d+(,-$-'6-
8 L-+( : '( d'( +?/# &'+(- (#'5
8 K+d' )-(4'5 : '(% *+(, d'( +?/# &'+(- (#'5
8 VU : -(+ -(-'5
K+6'( : +,+#-66
enis pe%eri&saan )/+),+*,)-
DARAH RUTIN
WBC 10!103<U5
RBC 3!0110<L
HGB 11!1 )<dL
PLT ;00103
HCT 31!0
KIMIA DARAH
GDS 7 )<d5
SGOT 21 <5
SGPT <5
U+ )<d5
K+',-(-( 0!3 )<d5
A5*-( 3!0 )<d5
E5+,#5-,
N' 139 #5<L
K !02 #5<L
C5 111 #5<L
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• Pe%eri&saan 0oto po"os a$o%en )*+),+*,)-
I(,+&+,'6-
8 d'' 66 ,+d-6,-*6- 6'&'- + d-6,'5
8 ,'&' d-5','6- 5##&85##& 66% ,-d' ,'&' )'*''( /+-() *#(+
8 +d' &6#'6 5-(+ ,-d' ,+-6'5-6'6-% +d' &+&+-,#(+'5 $', 5-(+ -(,'
8 ,5'() ,5'() '() ,+-6'5-6'6- -(,'
+6'( : +,+#-66
Pe%eri&saan 1o"on in Loop 2)3+),+*,)-4I(,+&+,'6-
8 Ud'' 66 ,+d-6,-*6- 6'&'- + d-6,'5 $+?'5 '66 -,-$
8 T'&' d-5','6- 5##&85##& 66 d'( ,-d' ,'&' )'*''( /+-()
*#(+ 6+,' '- $5-d 5++5!
8 K+d' &6#'6 5-(+ ,-d' ,+-6'5-6'6-
8 K+d' &+&+-,#(+'5 $', 5-(+ -(,'
8 K+6'( : ,-d' ,'&' ,'(d'8,'(d' 6,+(#6-6 '(-
7
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M+,+#-66
• Foto BNO 5 OMD 2*-+),+*,)-4
Foto BNO
I(,+&+,'6-
8 Ud'' 66 ,+d-6,-*6- 6'&'- + d-6,'5 d+()'( $+?'5 '66 -,-$
8 T'&' d-5','6- 5##&85##& 66 d'( ,-d' ,'&' )'*''( /+-()
*#(+ 6+,' '- $5-d 5++5
8 K+d' &6#'6 5-(+ ,-d' ,+-6'5-6'6-
8 K+d' &+&+-,#(+'5 $', 5-(+ -(,'
Foto %aa6uoeno6rap#7
I(,+&+,'6-
8 K#(,'6 6+('.' -#d- d-'6'( +5'5- )'6,-? ,*+ '()
,+&'6'() +5'5- #'5 6+*'(' ;05 ,'(&' ,'/'('( +()-6- )'6,+%
d#d+(% 4+4(
8 T-d' ,'&' $-55-() d+$+?, '&( 'dd-,-#('5 6/'d#.
Foto po"os a$o%en *8 9a%
I(,+&+,'6-
8 T-d' ,'&' 6-6' #(,'6
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K+6'( : ,-d' ,'&' ,'(d'8,'(d' 6,+(#6-6
G'*''( +,+#-66
9
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'II. RESUME
S+#'() '(' 5'-85'-% 6-' 23 /'-% '6 '/ 6'-, d+()'(
+5/'( &+, d-6,+(d+d '() d-'5'- 6+4' 6-' 7 /'- 6+,+5'/ +5'/-'(!
M(,'/ 'd'% $++(6- 1 '5-% ,-d' &#+,-5% -6- ?'-'( *+.'(' (-()!
R-.'', 6+-() (,'/ 'd'% 6+4' 6-' 7 /'-! B'() '- *+6' 6+d--,8
6+d--,% #(6-6,+(6- +(?+! A(' ,-d' &+('/ +('()-6 6'', *'() '-
*+6'! T-d' &+('/ $+6+6 *+?'& d''/! R-.'', '(' 6+)+' *'() '-
*+6' +#(- 6+,+5'/ 5'/-% *+.'(' /-4' +/-,''(! K+(?-() ,-d'
&+('/ +5' d'- 5*'() &'(,',! F+6+6 ,-d' &+('/ *+?'& '-
+(?-()! '(' ,-d' &+('/ +.+5 6'', *'() '- +?-5! B'() '- +?-5
5'(?'% .'(' (-()! T-d' 'd' )','58)','5 d- d'+'/ +'5'(! R-.'',
#&+'6- 6+*+5(' ,-d' 'd'! R-.'', &+())(''( 5'6',-$ ,-d' 'd'!
P++4''( ''/ &+,'(- d'( -* ,-d' *++4'!
R-.'', +5'/-'( : B'- 5'/- ?& *5'( = 29 -())> 5'/- 6&#(,'(
d-,#5#() d(% *'- 5'()6() +('()-6! B+', *'d'( 5'/- 3% )!
R-.'', +/'-5'( : I* ,-d' &+('/ ,+4',/% ,-d' &+('/ d+'% ,-d'
,++(' 'd-'6- ',' ,+'&- 'd-'6-% ,-d' &+('/ +()#(66- 4'
6+5'' +/'-5'(! )-@- -* *'- d'( /'(' -( -,'-( '()
d-+6+&'( d#,+ 6+5'' +/'-5'(! U6-' 6'', /'-5 2 ,'/(! G;P;A0
D'- &++-6''( $-6-6 d-d'&','( )'*''( : 6'-, 6+d'() < )-@-
?& < ?# +(,-6! T'(d' -,'5% ('d-: 120<+(-,% &+('&'6'(:
<+(-,% 6/: 3%9 0C!! P'd' +)-# '*d#+( -(6&+6- +*()% -,
)+' ('&'6% d' ?#(,# =8>% d' 6,+-$() =8>! A65,'6- d-d'&','( &+-6,'5,- => +6'( +(-()',% &'5&'6- '66' ,# =8>% (+- ,+'( =8>!
L-+( ,-d' ,+'*'! P+6- /-&+,-&'(-! P'd' &++-6''( ,/#'6 d'5'
*','6 (#'5! P'd' &++-6''( +?,'5 ,#?/+ d-d'&','( 6$-(),+
+(?+-% '('5-6 '('5 6+&-, ,+,'&- 4'- +5-()-() d'/ d-'6'(%
'&5' ,-d' #5'&6% #6' 5-?-(! H'(d6?/#+(: d''/=8> 5+(d-=8> $+6+6=>
D'- /'6-5 &++-6''( 5'*#',#- *+&' &++-6''( d''/ ,-(
d'( &++-6''( --' d''/ +((4'( d'5' *','6 (#'5! P'd'
10
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&++-6''( 'd-#5#)- '-, $#,# #6 '*d#+( d'( USG '*d#+(
d-d'&','( )'*''( +,+#-66!
'III. DISKUSI
STENOSIS ANI
A! D+$-(-6-
S,+(#6-6 '(- +&''( 6', +'d''( d-'(' 5+( '(6
+(+&-,! S,+(#6-6 '(- &'d' *'- 'd'5'/ +5'-('( #()+(-,'5 ','
*'.''(! S,+(#6-6 '(- 'd'5'/ ,-d' 5+()'&(' &++*'()'( +*-#(-
&'d' d-6,'5 '(6 d-'(' ,+4'd- &+*+(,'( +*'( '('5 '() ,-d'
6+&('! S,+(#6-6 '(- #()+(-,'5 +&''( 6', '5$#'6- '(#+,'5!
S+d'()'( 6,+(#6-6 '(- &'d' d+.'6' 6+-() ,+4'd- '-*', #&5-'6- d'-
#&+'6- &'d' d'+'/ '(#+,'5!
M'5$#'6- '(#+,'5 +&''( 6', 6&+, d'- '(#'5- #()+(-,'5
'() ,+d-- d'- '(6 -&+$#',' d'( 5#'' &+6-6,+(! A(6 -&+$#','
+&''( +5'-('( #()+(-,'5 ,'(&' '(6 ',' d+()'( '(6 ,-d' 6+&('%
6+d'()'( 5#'' &+6-6,+( d-'-*','( '+(' &+-6'/'( '(,'' ,',6
-('-6% ,',6 )+(-,'5-' d'( ,',6 d-)+6,-6 ,-d' ,+4'd-! M'5$#'6-
'(#+,'5 +&''( +6''( *+6&+, 5'6 &'d' &++*'()'( *')-'(
,+*'.'/ d'- 6'5'( -(,+6,-('5 d'( #)+(-,'5! K+,-' '5$#'6- ,+4'd-% #,#,
d'( 6''$ '() *+/*()'( d+()'( '(6 4)' 6+-() +()'5'-
'5$#'6- d'5' d+'4', '() 6''! D+$+ #5#)- 'd'5'/ '(#'5- '()
&'5-() 6+-() *+'-,'( d+()'( '5$#'6- '(#+,'5% d--,- d+$+ &'d'
+,+*'% +6,--,'6 d'( 6-6,+ 'd-#'65'!
P+('()'('( d-5''( &'d' *'- d+()'( '5$#'6- '(#+,'5
6+,+5'/ 2; 4'% '+(' ,+'('( -(,'5-('5 ''( +(-()', 6+/-())'
d'&', +(d##() +#(- +5' + &+-(+ &'d' +5'-('( 5+,'
+(d'/% ',' +5' +5'- +,/' &'d' +5'-('( 5+,' ,-())- d'( +*+-
.', *')- d'' (, ++(/- 66 /-())' +(?'&'- 4() d-6,'5
66! N'(% *-5' d-*-''( 5+*-/ d'- 2; 4'% *'- *++6-# +()'5'-
&+$#'6- '+(' d-6,+(6- '() *+5+*-/'(!
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B! E&-d+-#5#)-
M'5$#'6- '(#+,'5 ,+4'd- 6+,-'& 1 d'- !000 +5'/-'(!
M'5$#'6- -(- 5+*-/ 6+-() ,+4'd- &'d' &-' d'( &-' d' '5- 5+*-/ *'('
+()'5'- '5$#'6- '(#+,'5 5+,' ,-())- ',' -(,++d-+,! E&',
&5/ 6'&'- ,4/ &5/ &+6+( d'- &+(d+-,' +()'5'- 6', ',' 5+*-/
d+$+ ,'*'/'( d'- 6-6,+ #)'( 5'-(('! K+5'-('( '() &'5-() 6+-()
,+4'd- &'d' &-' 'd'5'/ '(6 -&+$#',' d+()' $-6,5' +,#+,'% d--,-
$-6,5' +,#&+-(+ +d-'( $-6,5' +,#+6-' ',' *5'dd+ (+?!
P'd' .'(-,'% '() ,+6+-() 'd'5'/ d+$+ +,#+6,-*5+% +d-'( $-6,5'
,'(+6&+-(+'5! "'() +,-)' '() ,+6+-() 'd'5'/ &+6-6,+( 5#''! L+6-
-(- 'd'5'/ '5$#'6- '() *+6&+, 5'6 d-'(' +,% ')-('% d'(
,',6 -('-6 *+,+ d'( *+6', +*+(, 6', 6'5'(! P'd'
&++-6''( $-6-% d'&', d-5-/', 6', 5*'() 6'4' &'d' &+-(+!
C! E*-#5#)-
S+?'' +*-#5#)-6% 6'5'( &+(?+(''( *+'6'5 d'- F#+),%
M-d), d'( H-(d),! F#+), ''( +*+(, $'-()% 6-6,+ &+('&'6'(
*')-'( *'.'/% +6#$')6% 5'*() 6+*')-'( d#d+(% /',- d'( 6-6,+
*-5-+ 6+,' &'(+'6! M-d), +*+(, 66 /'56% 6+*')-'( d#d+(%
6+% '&&+(d-% #5#( '6?+(d+( 6'&'- &+,+()'/'( #5#( ,'(6+6!
H-(d), +5'6 d'- -d), /-())' + +*'( 5#''% +*'( -(-
,+66( d'- +(d#d+ 5#''% d'( +,#d+ d'- &#,#d+ < '('5&-,!
H-(d), +*+(, 6+&+,-)' d-6,'5 d'( #5#( ,'(+6 % #5#(d+6+(d+(% 6-)#-d% +,% *')-'( ','6 '('5-6 '(-! E(d#d+ /-(d), -(-
4)' +*+(, 5'&-6'( d'5' '(d() +-/ d'( +,'! B')-'( '/-
/-(d), *+'' + d'5' 5#''% 6', #())' '() d-5'&-6- +(d#d+
'() *+/*()'( 5'()6() d+()'( +,#d+ &+''(! D'+'/
&+,+'( '(,'' +(d#d+ d'( +,#d+ +*+(, +*'(' 5#''!
P'd' &++*'()'( 6+5'(4,('% ,-*5 6', -)- +5-(,'()% '-,
6+&, #+,'5% &'d' 6d, '(,'' '55'(,#-6 d'( 66 *+5''()! S+', -(-
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,*/ + ''/ 'd'5% '+(' -, +*')- 5#'' +(4'd- *')-'(
'(,+-#% '-, 6-(6 #)+(-,'5-6 &--,-$% d'( *')-'( ,+-#% '-,
'('5-6 '(#+,'5-6! K+,-' 4'(-( *+ -())% 6+&, #+,'5
+(?'&'- +*'( 5#''% d'( d- d'+'/ -(- ,+*+(,5'/ #&6
&+-(+'5-6! M+*'( 5#'' +d-'( ,+*')- +(4'd- +*'(' '('5-6 d-
*+5''()% d'( +*'( #)+(-,'5-6 d-d+&'(! M+*'(' '('5-6 d-+5-5-()-
#5+/ ,#(4#5'(8,#(4#5'( +6+(-% d'( &'d' -()) +8 6+5'&, -(-
,+5+,' d- d'6' ?+()'( +,#d+% '() d-+('5 6+*')'- ?+5'/ '(6 ','
&#,#d+! P'd' -()) +89 +*'( '('5-6 #*+% d'( ,+*'5'/
4'5'( '(,'' +, d+()'( d(-' 5'! B')-'( ','6 '('5-6 '('5-6 *+'6'5
d'- +(d#d+ d'( d-&+d''/- #5+/ &+*5/ d''/ /-(d),% '-, ',+-
+6+(,+-' -($+-#! S+d'()'( 6+&+,-)' *')-'( *'.'/ '('5-6 '('5-6
*+'6'5 d'- +,#d+ d'( d-&+d''/- #5+/ ''! R+,'5+6% '() +&''(
?'*'() d'- ',+- &d+(d' -(,+('! T+&', &+6'*()'( '(,'' *')-'(
+(d#d+ d'( +,#d+ d-*+(, #5+/ 5-(+' &+,-(','% '() ,+d'&', ,+&',
d- *'.'/ #5(' '('5-6! P'd' )'-6 -(-% +&-,+5 *+*'/ d'- +&-,+5 ,#'
+(4'd- +&-,+5 *+5'&-6 )+&+()!
U66 ,+*+(, 5'- -()) ++&', d-6+*, 6+*')'- &--,-$ ),!
K+)')'5'( &++*'()'( '() 5+()'& d'- 6+&, #+,'5-6
+()/'6-5'( '(#'5- 5+,' ,-())- ',' 6&' 5+',#! S+d'()'( '(#'5-
5+,' +(d'/ ',' -($' 5+',# *+'6'5 d'- d+$+ &++*'()'(
&#,#d+ d'( 5-&','( )+(-,'5! P'd' '(#'5- 5+,' ,-())-% #,#, 5+',# '(-
&++*'()'((' ,-d' (#'5! S+d'()'( #,#, 6$-(),+ +6,+(6 d'(
-(,+(6 d'&', ,-d' 'd' ',' d-+(,+!
T'/'&8,'/'& &+,*/'( ,+4'd- &'d' $#'6- '(',#- (#'5d'- *')-'( *'.'/ '-, '(6% +, d'( 6'5'( #)+(-,'5! P'd' -())
+8; &+,*/'( ,+d'&', 5#'' d'( 6,, '() d-6+*, +*'(
5#''! K5#'' 'd'5'/ 6,, (#'5 &'d' *() d'( 'd' &'d' '(6-'
(, .', '() 6-()', &'d' ,'/'& &+,*/'(! S+*+5 '(6-'
5'/-% 5#'' 'd'5'/ 6,, d-'(' #5#(% 6'5'( -(% d'( )+(-,'5
*+'' +d-'( +5' d'- ,*/ +5'5- 6', 5*'()! M'(6-'
+5'5- 6', ,'/'& &+,*/'( d-'(' 5#'' +&''( 6,, '()
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DAFTAR PUSTAKA
1! B-6-(d' G% V'(+55' S% C'd+d F! Surgical treatment of anal stenosis!
W#5d J#('5 #$ G'6,#+(,+#5#)! 2009! I,'5
2! K/'( A!R% S'++d A% M'5- H!I! Neonatal Rectal Perforation : Rare
Complication of Anal Stenosis. J#('5 #$ P+d-',-? S)-?'5 S&+?-'5-,-+6!
2013! U(-,+d K-()d#
3. A(#(! R+?,'5 and Large Intestinal Atresia / Stenosis! M-((+6#,'
D+&',+(, #$ H+'5,/! #(5-(+ : ?-,+d N#+*+ 2% 2013 $# :
/,,&:<</+'5,/6,',+!(!6!
;! A(#(! Recommendation for Anal Dilatations ollo!ing Repair of
Imperforate Anus Repair ! C-(?-((',-# C/-5d+(6 C#5#+?,'5 C+(,+!
#(5-(+: ?-,+d N#+*+ 2% 2013 $# : ...!?-(?-((',-?/-5d+(6!?#
! B#5-6+,, "! Disease of Rectum and Anus! D!"#)-'6 L+?,+6 #(
S)+ P', II! 2009! U(-,+d S,',+
! G'' A!H! S#*'d# C! W! A5#(6# S!E! Surgical treatment of Anal
Stenosis : Assessment of "" Anoplasties. 200;! B'@-5