ILEUS PARALITIK

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 ILEUS?

Suatu keadaan terjadinya intestinal statis

atau disfungsi yang disertai pelebaran
lumen dan penebalan dinding.
Berdasarkan etiologinya, ileus dapat
dibedakan atas dua golongan:
Obstruksi mekanis
Intra luminar obstruction, misalnya tumor intra
luminar, intususepsi
Ekstrinsik obstruction, misalnya adhesi, inflamasi,
tumor ekstrinsik.
Obstruksi adinamik (ileus paralitik)
 ILEUS PARALITIK?

Suatu keadaan akut abdomen* berupa

kembung karena usus tidak
berkontraksi akibat adanya gangguan
motilitas

* Akut abdomen proses

intraabdomen yang menyebabkan
severe pain yang memerlukan
perawatan di RS dan sebelumnya
belum mendapat terapi/diperiksa dan
 ETIOLOGI ILEUS PARALITIK

Peritonitis
Ileus pasca bedah
Setelah trauma abdomen
Gangguan elektrolit
Metastase peritoneal yang difus
Obat-obatan ( obat spasmolitik )
 PATOFISIOLOGI

Pembedahan Post operasi

abdominal ileus
fisiologis hilang aktivasi refleks inhibisi dari arkus
dalam 2-3 hari spinal

Bila ileus menetap hipomotilitas traktus gastrointestinal
dalam waktu lebih dari
3 hari setelah otot dinding usus terganggu
pembedahan ileus
gagal untuk mengalirkan isi usus
paralitik
akumulasi gas dan cairan dalam usus
 MANIFESTASI KLINIS

Nyeri abdomen (sedang, difus)

Mual, muntah
Konstipasi absolut
Distensi abdomen
Pergerakan usus minimal, flatulence <<
Bunyi peristaltik kurang atau
menghilang
Defense muskular
 PERBANDINGAN KLINIS
Macam Nyeri Diste Muntah Bising usus Ketegan
ileus Usus nsi borborig gan
mi abdomen
Obstruksi ++ + +++ Meningkat -
simple (kolik)
tinggi
Obstruksi +++ +++ + Meningkat -
simple (Kolik) Lambat,
rendah fekal
Obstruksi ++++ ++ +++ Tak tentu +
strangulas (terus- biasanya
i menerus, meningkat
terlokalisir)

Paralitik + ++++ + Menurun -

Oklusi +++++ +++ +++ Menurun +
vaskuler
 GAMBARAN RADIOLOGIS

Terdapat distensi baik pada usus halus

maupun usus besar, termasuk lambung dan
rektosigmoid
Air-fluid level pada usus halus dan usus besar
muncul hanya jika ileus bertahan sampai 5-7
hari.
Seluruh rongga usus terisi udara
Preperitoneal fat menjadi tipis atau kadang
menghilang
Membentuk gambaran herring bone (duri ikan)
atau bag of popcorn
 CRITERIA OBSTRUKTIF PARALITIK

More air proximal to the No preferential

GAS
obstruction than distal collection of air.
DISTRIBUTION
to it.
BOWEL Dilatation proximal to Generalized dilatation
DILATATION the site of obstruction. of all bowel.

Many dilated air-fluid Fewer air-fluid level

AIR-FLUID LEVEL
levels. that are not dilated.
step ladder Herring bone or
appearance or more resembles a bag of
ARRANGEMENT
orderly arrangement popcorn (less orderly
OF BOWEL LOOPS
(resembles a bag of arrangement).
sausages).
PREPERITONEAL (+) (-)
FAT
Jika:
-terdapat dilatasi lokal (mis. Usus halus saja)
-terdapat pada suatu bagian usus tempat distensi berakhir (mis.
Pertengahan kolon transversum)
-rektum kosong tidak terisi gas

curiga obstruksi mekanis

Jika: seluruh bagian usus dan curiga ileus

gaster dilatasi paralitik
(1) ILEUS PARALITIK (7 DAY OLD
FEMALE)
 (1) INTERPRETASI
Gas Distribution: There are pockets of gas
scattered in several areas of the abdomen. There
is gas in the small bowel, colon, and rectum.
Bowel Dilatation: There is mild dilation of the
bowel, mostly in the colon. The dilated segment
of bowel in the left upper quadrant shows
relatively smooth bowel walls. However, most of
the bowel does not show this. In other words, the
haustra and plicae of most of the bowel are well
preserved.
Air-Fluid Levels: None.
Arrangement of Loops: The loops are not
arranged in an orderly pattern.
(2) ILEUS PARALITIK (1 MONTH
OLD FEMALE)
 (2) INTERPRETASI
Gas Distribution: There is a lot of gas in
the small and large bowel distributed
throughout the abdomen.
Bowel Dilatation: The degree of bowel
dilation here is proportional throughout.
In other words, the large bowel is slightly
dilated, as is the small bowel.
Air-Fluid Levels: None.
Arrangement of Loops: Disorderly
arrangement of dilated bowel. This
resembles a bag of popcorn rather than
a bag of sausages.
(3) ILEUS PARALITIK (3 DAY OLD
FEMALE)
 (3) INTERPRETASI
Gas Distribution: Generalized presence of
gas throughout all quadrants.
Bowel Dilatation: The degree of bowel
dilatation is proportional. The right lower
quadrant may demonstrate some smooth
bowel walls, but this is probably just the
descending colon. Some of the haustra in
these segments are still preserved. For the
remainder of the bowel, the haustra and
plicae are well preserved.
Air-Fluid Levels: None.
Arrangement of Loops: Disorderly
arrangement resembling a bag of popcorn.
 SUMBER
Livingstone AS, Sasa JL. Ileus and obstruction in Haubrich WS,
Schaffner F (eds); Bockus Gastroenterology 5th ed. Philadelphia, WB
Saunders Co., 1995
Sileu W. Acute intestinal obstruction. In : Isselbacher KJ, Braunwald E,
Wilson JD, Martin JB, Fauci AS, Kasper DL (eds). Harrisons Principles
of Internal Medicine 13th ed : New York, Mc Graw-Hill, 1994
Schuffer WD, Sinanan MN. Intestinal obstruction and
pseudoobstruction in : Sleissenger MH, Fordtran JS (eds).
Gastrointestinal Disease; Pathophysiology/ Diagnosis / Management
5th ed. Philadelphia, WB Saunders Co, 1993
Livingstone EH, Passoro EP. Postoperative ileus. Dig. Dis. Sci. 1990;
35 : 121-32
Saudgren JE, Mc Phee MS, Greenberger NJ. Narcotic bowel syndrome
treated with clonidin. Resolution of abdominal pain and
pseudoobstruction. Ann Intern Med 1990; 101 : 331-4.