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MECONIUM ILEUSMECONIUM ILEUS

Pediatric Surgery Jay L. Grosfeld

Text Book Reading

Dr. Iwan S.



MECONIUM ILEUSMECONIUM ILEUS

Landsteiner (1905):Landsteiner (1905): observasi obstruksiobservasi obstruksi

usus haus !enderita d" keainan !ankreasusus haus !enderita d" keainan !ankreas ada hubun"an den"an de# en$i%ada hubun"an den"an de# en$i%

cystic brosiscystic brosis

→→ 20,8%20,8% !enderita di &S!enderita di &S

Etioo"i unkno'n "enetiEtioo"i unkno'n "eneti

**



+&,-O.ENESIS+&,-O.ENESIS

Muai ter/adi di intrauterin seba"aiMuai ter/adi di intrauterin seba"aihasi aku%uasi %ekoniu% viskositashasi aku%uasi %ekoniu% viskositas

tin""i dan !adat:tin""i dan !adat: esiensi en$i% !ankreas danesiensi en$i% !ankreas dansekresi %ukus 2an" kenta oehsekresi %ukus 2an" kenta oeh

keen/ar usus abnor%akeen/ar usus abnor%a

aku%uasiaku%uasidan obstruksi %ekoniu%dan obstruksi %ekoniu%intrau%inaintrau%ina ko%!ikasiko%!ikasi



.&M3&4&N LINI .&M3&4&N LINI

Uno%!iated %eoniu% ieusUno%!iated %eoniu% ieus

Se"era seteah ahir6 ditandai d"nSe"era seteah ahir6 ditandai d"n

distensi abdo%en6 %ekoniu% 2an"distensi abdo%en6 %ekoniu% 2an"kenta %en2u%bat usus6 %untahkenta %en2u%bat usus6 %untahhi/au6 tidak bisa 3&3*hi/au6 tidak bisa 3&3*



Co%!iated %e ieus6Co%!iated %e ieus6

Intrauterin atau seteah ahirIntrauterin atau seteah ahir !er#orasi dan atau nekrosis usus:!er#orasi dan atau nekrosis usus:"a%baran kasikasi berbentuk buan"a%baran kasikasi berbentuk buansabit atau butiran7butiran intra abd6sabit atau butiran7butiran intra abd6!eritonitis6 erite% atau ede%a dd" abd!eritonitis6 erite% atau ede%a dd" abddan atau n2eri tekan abd*dan atau n2eri tekan abd*

Si%!e %e ieusSi%!e %e ieus

3a2i atau de'asa %uda3a2i atau de'asa %uda %e ieus %e ieus

e8uivaent or dista ieae8uivaent or dista ieaobstrution s2ndrobstrution s2ndr



4i'a2at C 107;;6 a%niosintesis4i'a2at C 107;;6 a%niosintesisaurate dia"nosisaurate dia"nosis

Seria US. intrauterin intestinaSeria US. intrauterin intestinaobstr o# %e ieus (about <0 o# theobstr o# %e ieus (about <0 o# theC !o!uation) 'ith or 'ithout aC !o!uation) 'ith or 'ithout ao%!iatin" %eoniu% 2st*o%!iatin" %eoniu% 2st*



+oihidra%nion %en""a%barkan+oihidra%nion %en""a%barkanadan2a %ekoniu% ieus intrauterin6adan2a %ekoniu% ieus intrauterin62an" berasa dari obstruksi usus2an" berasa dari obstruksi usus

berat*berat*

si%!e atau uno%!iated:si%!e atau uno%!iated:

!eritonitis (7)!eritonitis (7)



+e%eriksaan sik+e%eriksaan sik

istensi abdo%en !ada saat ba2iistensi abdo%en !ada saat ba2iahirahir

+eristatik usus terihat dan teraba6+eristatik usus terihat dan teraba6

kadan" terihat "a%baran ususkadan" terihat "a%baran usus +U,,= SI.N> !a!ated %ass+U,,= SI.N> !a!ated %ass

4,: ,idak ada %ekoniu% 2an" keuar4,: ,idak ada %ekoniu% 2an" keuar

,eraba %assa6 !erubahan 'arna ,eraba %assa6 !erubahan 'arnadd" abd6 dan tanda7tanda !eritonitisdd" abd6 dan tanda7tanda !eritonitis

-2!ovoe%ia-2!ovoe%ia

N., kehi/auan ? <0 %N., kehi/auan ? <0 %



Laboratoriu%Laboratoriu%

&naisa tri!sin dan h2%otr2!sin&naisa tri!sin dan h2%otr2!sin

#eses#eses ,r2!sin @ A0 %"B" ,r2!sin @ A0 %"B"

CC i%%unoreative tr2!sino"en i%%unoreative tr2!sino"en

darahdarah



I I&.I I&.

Neonata intestina obstrution:Neonata intestina obstrution:

Iea atresiaIea atresia-irshs!run"s disease-irshs!run"s disease

Neonata s%a e#t oonNeonata s%a e#t oon

Meoniu% !u" s2ndro%eMeoniu% !u" s2ndro%e



MANAGEMENTMANAGEMENT

Non operativeNon operative

,er"antun" dari ins!issated intrau%ina ,er"antun" dari ins!issated intrau%ina%eoniu% dan !atensi dari ieokoon*%eoniu% dan !atensi dari ieokoon*Nobett desribed :Nobett desribed :

1* ontrast ene%a1* ontrast ene%a dista intestina obst dista intestina obst

<* o%! o#<* o%! o#vovuus6atresia6!er#oration6!eritonitisvovuus6atresia6!er#oration6!eritonitiseDudedeDuded;* ene%a 'ith are#u uroso!i ontro;* ene%a 'ith are#u uroso!i ontroF* Intravenous antibiotiF* Intravenous antibioti5* +ediatri sur"eon5* +ediatri sur"eonG* #u uid resusitationG* #u uid resusitationH* Shoud be !re!ared #or i%%inentH* Shoud be !re!ared #or i%%inento!erationo!eration



.astro"ran ene%a.astro"ran ene%a %e"u%ine %e"u%ineditria$one(t'een A0)6F0 sodiu%ditria$one(t'een A0)6F0 sodiu%diatri$oatdiatri$oat

soubii$in" ene%a treat%entsoubii$in" ene%a treat%ent "uideines "uideinesNobett uorosko!i "uidane danNobett uorosko!i "uidane dan!e%berian arutan "astro"ran 50 daa%!e%berian arutan "astro"ran 50 daa%

air abdo%ina radio"ra!h diuan" daa%air abdo%ina radio"ra!h diuan" daa%A71< /a% obstruksi (7)A71< /a% obstruksi (7)

,he suess o# nono!erative treat%ent is ,he suess o# nono!erative treat%ent is

variabevariabe



Operative anageentOperative anageent

Sip!e Me"oni# I!e#$Sip!e Me"oni# I!e#$

,u/uan ,u/uan %en"hian"kan obstruksi:%en"hian"kan obstruksi:

evakuasi %ekoniu% atau reseksievakuasi %ekoniu% atau reseksiba"ian 2an" %en"andun" ins!issatedba"ian 2an" %en"andun" ins!issated%ateria%ateria

a*a* Enteroto%ies 'ith irri"ation ou!edEnteroto%ies 'ith irri"ation ou!ed'ith a i%ited resetion'ith a i%ited resetion

b*b* ,he Miui$ resetion and ,he Miui$ resetion andenteresto%2enteresto%2

** ,he 3isho!7koo! resetion and ,he 3isho!7koo! resetion andenterosto%2enterosto%2

d*d* ,he Santui enterosto%2 ,he Santui enterosto%2

e*e* ,ube enteresto%2 ,ube enteresto%2



riteria 3isho!7koo! !rosedurriteria 3isho!7koo! !rosedur

1* Li%it intao!erative bo'e trau%a1* Li%it intao!erative bo'e trau%a<* 4eset dis!arate2 iea oo!<* 4eset dis!arate2 iea oo!

;* Create a!!ro!riate2 si$ed end to;* Create a!!ro!riate2 si$ed end to

sideside anasto%osisanasto%osisF* Insertin" atheter into distaF* Insertin" atheter into distabo'ebo'e

5* Enterosto%2 osure b2 i"ation5* Enterosto%2 osure b2 i"ationc#i$"ey sto$ac#i$"ey sto$a



SantuiSantui

a !roDi%a hi%ne2 enterosto%26a !roDi%a hi%ne2 enterosto%26

an o!eration that in essene is thean o!eration that in essene is thereverse o# the resetion ou!edreverse o# the resetion ou!ed'ith a dista hi%ne2 enterosto%2'ith a dista hi%ne2 enterosto%2



Cop!i"ated Me" I!e#$Cop!i"ated Me" I!e#$

-a%!ir seau d"n o!erasi-a%!ir seau d"n o!erasi

Indikasi : !ersistin" intestina obst6Indikasi : !ersistin" intestina obst6

enar"in" abdo%ina %ass6 si"nenar"in" abdo%ina %ass6 si"no# !eritonitis6 dan inia and abo# !eritonitis6 dan inia and absi"n o# on"oin" se!sissi"n o# on"oin" se!sis



Meoniu% !eritonitis %eoniu%Meoniu% !eritonitis %eoniu%

au%uatin" in !eritonia avit2 au%uatin" in !eritonia avit2 & aied& aied !seudocyst !seudocyst brous 'abrous 'aand s!ared bo'e oo!and s!ared bo'e oo!

&t o!eration %andator2 asses&t o!eration %andator2 assesresidua intestina en"thresidua intestina en"th



+osto!erative %ana"e%ent+osto!erative %ana"e%ent

Su!!ort o# the in#antJsSu!!ort o# the in#antJs"enera !h2sioo"i"enera !h2sioo"i



o%!ikasio%!ikasi

.asrointestina.asrointestinaa*a* Intussue!tionIntussue!tion

b*b* 4eta !roa!se4eta !roa!se

** Cooni stritureCooni striture

+u%onar2+u%onar2a*a* 3ateria se!sis3ateria se!sis

b*b* 3ronho!ne%onia3ronho!ne%onia

In"uinosrota iseaseIn"uinosrota iseasea*a* -ernia and h2droee-ernia and h2droee

b*b* Cr2!torhidis%Cr2!torhidis%



TERIMA %ASI&TERIMA %ASI&

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