B BAAGGIIAAN N IILLMMU U BBEEDDAAHH F FAAKKUULLTTAAS S KKEEDDOOKKTTEERRAAN N MMaarreet t 22001144 UNIVERSITAS HASANUDDIN UNIVERSITAS HASANUDDIN STENOSIS
STENOSIS DUODENUMDUODENUM
OLEH : OLEH :
DISUSUN
DISUSUN OLEH OLEH ::
DANTY
DANTY INDRIASTUTYINDRIASTUTY C
C 11111 1 09 09 762762
DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
BAGIAN ILMU BEDAH FAKULTAS KEDOKTERAN BAGIAN ILMU BEDAH FAKULTAS KEDOKTERAN
UNIVERSITA
UNIVERSITAS S HASANUDDINHASANUDDIN MAKASSAR
MAKASSAR 2014 2014
I. ANATOMI DAN FISIOLOGI DUODENUM
Intet!n"# ten"e #er"$a%an
&r'an $en(ernaan )an'
er!n' *"'a +!e,"t e,a'a! #a-- !ntet!ne ata" "" %e(!-. "" /a-" Intet!n"# ten"e #en'/","n'%an 'ater +en'an a-"--a !-e&(ae(a- ,a"/!n!3 )an' #er"$a%an ,ata antara !ntet!n"# ten"e +en'an !ntet!n"# (ra"# Se-"r"/ &r'an )an'
ter#a"% +a-a# !ntet!n"# ten"e *"'a #er"$a%an &r'an&r'an !ntra$er!t&nea- Intet!n"# ten"e ter+!r! ata +"&+en"#5 *e*en"#5 +an !-e"#
D"&+en"# ata" *"'a +!e,"t +en'an "" 12 *ar! #er"$a%an "" )an' ,er,ent"% e$ert! /"r"6 7 )an' #en'/","n'%an antara 'ater +en'an *e*"n"# D"&+en"# #e-en'%"n' +! e%!tar (a$"t $an(rea D"&+en"# #er"$a%an ,a'!an ter#!na-. #"ara +ar! )te# a$$arat" ,!-!ar! +ar! /e$ar #a"$"n +ar! $an(rea Se-a!n !t" +"&+en"# *' #er"$a%an ,ata a%/!r +ar! a-"ran (erna ata D!#ana a-"ran (erna +!$!a/%an #*+ a-"ran (erna ata +an ,a8a/ &-e/ a+an)a -!' Tre!t9 # "$en&r!"# +"&+en!3 )an' ter-eta% $a+a 6-e"ra +"&+en&*e*"na-e )an' #er"$a%an ,ata antara +"&+en"# +an *e*"n"# D! +a-a# -"#en +"&+en"# ter+a$at -e%"%an2 %e(!- )an' +!e,"t +en'an $-!(a !r("-ar! D"&+en"# ter-eta% +! (a"# a,+&#en $a+a re'!& e$!'atr!"# +an "#,!-!%a-! D"&+en"# #e#!-!%! $en''ant"n' )an'
+!e,"t +en'an #e&+"&+en"# D"&+en"# ter+!r! ata ,e,era$a ,a'!an : a D"&+en"# $ar S"$er!&r
Ba'!an !n! ,er#"-a +ar! $)-&r" +an ,er*a-an %e !! %anan erte,rae -"#,a- I +an ter-eta% +! -!nea tran)-&r!(a Ba'!an !n! ter-eta% et!n''! Verte,rae L"#,a-I5 +an #e#!-!%! )nt&$! :
Anter!&r : -&," ;"a+ar!at" /e$at!5 e!(a 6e--ea
P&ter!&r : ,"ra &#enta-!5 a 'atr&+"&+ena-!5 +"(t" (/&-e+&("5 $&rtae /e$at! +an V (aa !n6er!&r
S"$er!&r : 6&ra#en e$!$-&!(a 8!n-&8 In6er!&r : (a$"t $an(rea
, D"&+en"# $ar De(en+en
Mer"$a%an ,a'!an +ar! +"&+en"# )an' ,er*a-an t"r"n et!n''! Verte,rae L"#,a- II < III Pa+a +"&+en"# ,a'!an !n! ter+a$at $a$!--a +"&n+en! #a*&r +an #!n&r5 )an' #er"$a%an #"ara +ar! +"(t" $an(reat!(" #a*&r +an +"(t" (/&-e+&("5 *' &-e/ +"(t" $an(reat!(" #!n&r )an' #er"$a%an &r'an a$$arat" ,!-!ar! )an' #er"$a%an &r'an2 )te# enter&/e$at!( D"&+en"# ,a'!an !n! #e#!-!%! )nt&$! :
Anter!&r : 6"n+" e!(a 6e--ea5 (&-&n traner"#5 -&," /e$at! +etra5 -e%"%an "" /a-"
P&ter!&r : "reter +etra5 /!-" rena-! +etra Me+!a- : (a$"t $an(rea
Latera- : (&-&n a(en+en5 6-e"ra (&-! +etra5 -&," /e$at! +etra ( D"&+en"# $ar
H&r!9&nta-Mer"$a%an ,a'!an +ar! +"&+en"# )an' ,er*a-an /&r!9&nta- %e !n!tra #en'!%"t! $!n''!r ,a8a/ (a$"t $an(rea +an #e#!-!%! %e-et&$! et!n''! Verte,rae L"#,a- II D"&+en"# ,a'!an !n! #e#!-!%! )nt&$! :
Anter!&r : #eenter!"# "" /a-"5 aa Meenter!(a "$er!&r5 -e%"%an *e*"n"#
P&ter!&r : "reter +etra5 # $&a +etra5 V7S5 a&rta S"$er!&r : (a$"t $an(rea
In6er!&r : -e%"%an *e*"n"# + D"&+en"# $ar A(en+en
Mer"$a%an ,a'!an tera%/!r +ar! +"&+en"# )an' ,er'era% na!% /!n''a $a+a 6-e"ra +"&+en"*e*"na-e )an' #er"$a%an ,ata antara +"&+en"# +an *e*"n"# Pa+a 6-e"ra +"&+en&*e*"na-e !n! ter+a$at -!'a#ent"# )an' #en''ant"n' )an' #er"$a%an -!$atan $er!t&ne"# )an' +!e,"t +en'an -!' Tre!t9 # "$en&r!"# +"&+en!3 )an' +!#ana -!'a#ent"# !n! *"'a #er"$a%an ,ata )an' #e#,a'! a-"ran (erna #*+ a-"ran (erna ata +an a-"ran (erna ,a8a/ D"&+en"# ,a'!an !n! #e#!-!%! %e-et&$! et!n''! Verte,rae L"#,a- I ata" II D"&+en"# ,a'!an !n! #e#!-!%! )nt&$! :
Anter!&r : #eenter!"#5 -e%"%an *e*"n"#
P&ter!&r : $!n''!r %!r! a&rta 5 $!n''!r #e+!a- # $&a !n!tra
Va%"-ar!a! D"&+en"#
Va%"-ar!a! +"&+en"# ,a!% arter! #a"$"n ena n)a ter,a'! #en*a+! 2 Unt"% +"&+en"# $ar "$er!&r /!n''a +"&+en"# $ar +e(en+en +!ata $a$!--a +"&+en! #a*&r #"ara +"(t" $an(ret!(" #a*&r35 +!a%"-ar!a! &-e/ R "$er!&r a $an(rear!(&+"&+ena-! (a,an' +ar! a 'atr&+"&+ena-!5 (a,an' +ar! a /e$at!(a
(&##"n!5 (a,an' +ar! tr!$-e /a--er) )an' +!(a,an'%an +ar! a&rta et!n''! Verte,ae T/&ra(a- =II < Verte,rae L"#,a- I +an a-!ran ena n)a -'' ,er#"ara %e )te# $&rtae
Se+an'%an +!,a8a/ $a$!--a +"&+en! #a*&r5 +"&+en"# +!a%"-ar!a! &-e/ R +"&+ena-! a #eenter!(a "$er!&r )an' +!(a,an'%an +ar! a&rta et!n''! Verte,rae L"#,a- I Se+an'%an a-!ran ena n)a ,er#"ara %e #eenter!(a "$er!&r
>
Innera! D"&+en"#
D"&+en"# +! !nnera! &-e/ $erara6an !#$at! &-e/ tr"n(" )#$at!(" e'#en t/&ra(a- VI=II5 +en'an%n $erara6an $ara!#$at! n)a &-e/ n a'" n =3
Pa+a +"&+en"# $ar "$er!&r e(ara /!t&-&'!t ter+a$at a+an)a e- -!,er%e"/n )an' ,er6"n'! "nt"% #e#$r&+"%! e*"#-a/ ,aa Baa !n! ,er6"n'! "nt"% #ena!%%an $H +ar! (/)#" )an' #a"% %e +"&+en"# +ar! 'ater5 e/!n''a $er#"%aan +"&+en"# ta+! ter!r!ta! +en'an a+an)a (/)#" )an' aa# ta+!
Se-a!n !t"5 $a+a +"&+en"# ter*a+! $r&e $en(ernaan %ar,&/!+ar!at e(ara en9)#at!( )an' te-a/ ,er,ent"% +!a%ar!+a D!#ana +"&+en"# #en+a$at%an #"ara +ar! +"(t" $an(reat!("5 +!#ana $a+a $an(rea +!$r&+"%! en9)#e #a-tae5 -a(tae +an "%rae D!#ana en9)#e #a-tae a%an ,er6"n'! "nt"% #e#e(a/ 1 '"'" '"-a #a-t&e #*+ 2 '"'" '"-a '-"%&a S+en'an%n -a(tae a%an #er",a/ 1 '"'" '"-a -a%t&a #*+ 1 '"'" '-"%&a +an 1 '"'" 'a-a%t&a Se#entara !t"5 en9)#e "%rae a%an #e#e(a/ 1 '"'" "%r&a #*+ 1 '"'" 6r"%t&a +an 1 '"'" '-"%&a
Se#entara !t"5 +! +a-a# +"&+en"# *' ter*a+! $en(ernaan -!$!+ e(ara en9)#at!( D!#ana -!$!+ +a-a# ,ent"% +!a!-'-!er&- a%an tere#"-! &-e/ a+an)a 'eta/ e#$e+" )an' +!a-!r%an #-- +"(t" (/&-e+&(" +ar! e!(a 6e--ea +an /e$ar Sete-a/ !t"5 e#"-! -e#a% ta+! a%an +!",a/ &-e/ en9)#e -!$ae $an(rea #*+ aa# -e#a% +an 2 +!a!-'-!er&-
II. EPIDEMIOLOGI
In!+en &,tr"%! +"&+en"# ,erar!a! antara1 +ar! 10000 /!n''a 1 +ar! 40000 %e-a/!ran Ke,an)a%an +!$er&-e/ $er,an+!n'an antara atre!a +an ten&! a+a-a/ ?:2 ata" 2:2 Atre!a +"&+en"# +an ten&! a+a-a/ $en)e,a, terer!n' +ar! &,tr"%! !ntet!n"# $a+a ,a)! )an' ,ar" -a/!r
O,tr"%! +"&+en"# ,er%a!tan +en'an $re#at"r!ta 4@3 +an $&-)/!+ar!a#n!&n #aterna- ??3 Se,a'a! ta#,a/an5 ter+a$at an'%a %e*a+!an )an' t!n''! /","n'an antara &,tr"%! +"&+en"# +an e*"#-a/ an&#a-!5 )a!t" +&8n )n+ar!&#e ?035 #a-r&ta! 2035 %e-a!nan *ant"n' ,a8aan 203
III. ETIOLOGI
O,tr"%! !ntr!n!% $a+a +"&+en"# ter*a+! a%!,at %e'a'a-an a%"&-!a! +an re%ana-!a!
IV. PATOFISIOLOGI
Pen)"#,atan !ntet!na- #e%an!% )an' ter*a+! %arena a+an)a +a)a #e%an!% )an' ,e%er*a ata" #e#$en'ar"/! +!n+!n' "" e/!n''a #en)e,a,%an $en)e#$!tan ata" $en)"#,atan -"#en "" Ha- tere,"t #en)e,a,%an $aae -"#en "" ter'an''" Se/!n''a ter*a+! $en'"#$"-an !! -"#en "" )an' ,er"$a 'a +an (a!ran $a+a ,a'!an $r&%!#a- te#$at $en)"#,atan )an' #en)e,a,%an $e-e,aran +!n+!n'
"" +!ten!3
A8a-n)a5 $er!ta-t!% $a+a ,a'!an $r&%!#a- "" #en!n'%at e,a'a! %&#$ena! a+an)a "#,atan ata" /a#,atan B!-a &,tr"%! ter" ,er-an*"t +an ter*a+! $en!n'%atan te%anan !ntra-"#!na-5 #a%a ,a'!an $r&%!#a- +ar! "" t!+a% a%an ,er%&ntra%! +en'an ,a!% +an ,!!n' "" #en*a+! t!+a% terat"r +an /!-an'
Pen!n'%atan te%anan !ntra-"#!na- +an a+an)a +!ten! #en)e,a,%an 'an''"an a%"-er ter"ta#a ta! ena D!n+!n' "" #en*a+! "+e# +an ter*a+! tran-&%a! ,a%ter! %e $e#,"-"/ +ara/ Pr&+"%! t&%!n )an' +!e,a,%an &-e/ a+an)a tran-&%a! ,a%ter! #en)e,a,%an t!#,"-n)a 'e*a-a !te#!% E6e% -&%a- $ere'an'an "" a+a-a/ !%e#!% a%!,at ne%r&! +!erta! a,&r,! t&%!nt&%!n ,a%ter! %e +a-a# r&n''a $er!t&ne"# +an !r%"-a! !te#!% Ha- !n! ,!aan)a ter*a+! $a+a &,tr"%! "" +en'an
tran'"-a! Ba/a)a "#"# +ar! %ea+aan !n! a+a-a/ e$!
Pa+a &,tr"%! #e%an!% e+er/ana5 /a#,atan $aae #"n("- tan$a +!erta! 'an''"an a%"-er +an ne"r&-&'!% Ma%anan +an (a!ran )an' terte-an5 e%re! "" +an "+ara a%an ,er%"#$"- +a-a# *"#-a/ )an' ,an)a% *!%a &,tr"%!n)a %&#$-!t Ba'!an $r&%!#a- +ar! "" #en'a-a#! +!ten! +an ,a'!an +!ta-n)a %&-a$ F"n'! e%re! +an a,&r,! #e#,ran #"%&a "" #en"r"n +an +!n+!n' "" #en*a+! e+e#a +an %&n'et! D!ten! !ntet!na- )an' ,erat +en'an en+!r!n)a e(ara ter" #ener" +an $r&'re!6 a%an #en'a(a"%an $er!ta-t!% +an 6"n'! e%re! #"%&a erta #en!n'%at%an r!!%& ter*a+!n)a +e/!+ar!a!5 !%e#!%5 ne%r&!5 $er6&ra!5 $er!t&n!t! +an %e#at!an
Ge*a-a "ta#a +ar! !-e" &,tr"%! antara -a!n n)er! %&-!% a,+&#en5 #"a-5 #"nta/5 $er"t +!ten! +an t!+a% ,!a ,"an' a!r ,ear &,t!$a!3 M"a- #"nta/ "#"#n)a ter*a+! $a+a &,tr"%! -eta% t!n''! B!-a -&%a! &,tr"%! +! ,a'!an +!ta-#a%a 'e*a-a )an' +&#!nan a+a-a/ n)er! a,+&#en D!ten! a,+&#en ter*a+! ,!-a &,tr"%! ter" ,er-an*"t +an ,a'!an $r&%!#a- "" #en*a+! an'at +!-ata! O,tr"%! $a+a "" /a-" #en!#,"-%an 'e*a-a e$ert! n)er! $er"t e%!tar "#,!-!%" ata" ,a'!an e$!'atr!"# Pa!en +en'an &,tr"%! $art!a- ,!a #en'a-a#! +!are Ka+an' < %a+an' +!-ata! +ar! "" +a$at +!ra,a O,tr"%! $a+a %&-&n ,!aan)a #e#$"n)a! 'e*a-a %-!n! )an' -e,!/ r!n'an +!,an+!n' &,tr"%! $a+a "" /a-" U#"#n)a 'e*a-a ,er"$a %&nt!$a! )an' ,era%/!r $a+a &,t!$a! +an +!ten! a,+&#en M"nta/ *aran' ter*a+!
Pa+a &,tr"%! ,a'!an $r&%!#a- "" /a-" ,!aan)a #"n("- 'e*a-a #"nta/ )an' ter+!r! +ar! (a!ran *ern!/ /!*a" ata" %"n!n' +an ter-!/at +!n! +a-a# $er*a-anan U" +!+e%&#$re! +en'an re'"r'!ta!5 e/!n''a ta% ter-!/at +!ten! C!%a &,tr"%! +! +!ta- +! +a-a# "" /a-" ata" %&-&n5 #a%a #"nta/ t!#,"- -a#,at +an ete-a/ #"n("-+!ten! M"nta/ann)a %enta- +an ,er,a" ,""% 6e%"-en3 e,a'a! /a!- $ert"#,"/an ,a%ter! ,er-e,!/an e%"n+er ter/a+a$ ta'nan!
N)er! $er"t ,erar!a! +an ,er!6at !nter#!ttent ata" %&-!% +en'an $&-a na!% t"r"n C!%a &,tr"%! ter-eta% +! ,a'!an ten'a/ ata" -eta% t!n''! +ar! "" /a-" *e*en"# +an !-e"# ,a'!an $r&%!#a-3 #a%a n)er! ,er!6at %&ntan.#eneta$
VI. PEMERIKSAAN PENUNJANG
La,&rat&r!"#
Te -a,&rat&r!"# #e#$"n)a! %eter,ataan n!-a! +a-a# #ene'a%%an +!a'n&!5 teta$! an'at #e#,ant" #e#,er!%an $en!-a!an ,erat r!n'ann)a +an #e#,ant" +a-a# re"!ta! Pa+a ta/a$ a8a-5 +!te#"%an /a!- -a,&rat&r!"# )an' n &r#a-
Se-an*"tn)a +!te#"%an a+an)a /e#&%&nentra!5 -e"%&!t&! +an n!-a! e-e%tr&-!t )an' a,n&r#a- Pen!n'%atan er"# a#!-ae er!n' +!+a$at%an Le"%&!t&! #en"n*"%%an a+an)a !%e#!% ata" tran'"-a!5 teta$! /an)a ter*a+! $a+a ? 0 &,tr"%! tran'"-a! +!,an+!n'%an 2 44 $a+a &,tr"%! n&n tran'"-ata He#at&%r!t )an' #en!n'%at +a$at t!#,"- $a+a +e/!+ar!a! Se-a!n !t" +a$at +!te#"%an
a+an)a 'an''"an e-e%tr&-!t Ana-!a 'a +ara/ #"n'%!n ter'an''"5 +en'an a-%a-&! #eta,&-!% ,!-a #"nta/ ,erat5 +an #eta,&-!% a!+&! ,!-a a+a tan+a < tan+a /&(%5 +e/!+ar!a! +an %et&!
Ra+!&-&'!%
Pa+a 6&t& $&!! te'a% a%an ta#$a% ,a)an'an a!r 6-"!+ -ee- )an' ,an)a% +! ,e,era$a te#$at #"-t!$-e a!r 6-"!+ -ee-3 )an' ta#$a% ter+!tr!,"! +a-a# ""nan tan''a te$ -a++er a$$earan(e35 e+an'%an "" e,e-a/ +!ta- +ar! &,tr"%! a%an ta#$a% %&&n' C"#-a/ -&&$ +ar! "" /a-" )an' ,er+!-ata! e(ara "#"# #en"n*"%%an t!n'%at &,tr"%! B!-a *"#-a/ -&&$ e+!%!t ,erart! &,tr"%! "" /a-" -eta%n)a t!n''!5 e+an'%an ,!-a *"#-a/ -&&$ -e,!/ ,an)a% #a%a &,tr"%! "" /a-" -eta%n)a ren+a/ Se#a%!n +!ta- -eta% &,tr"%!5 *"#-a/ a!r 6-"!+ -ee- a%an e#a%!n ,an)a%5 +en'an t!n''! )an' ,er,e+a,e+a e/!n''a ,er,ent"% te$ -a++er a$$ear an(e Ba)an'an "+ara +! +a-a# %&-&n ,!aan)a ter-eta% -e,!/ %e $er!6er +an ,!aan)a ,er,ent"% /"r"6 U ter,a-!% O,tr"%! %&-&n +!tan+a! +en'an +!-ata! $r&%!#a- %&-&n a#$a! %e te#$at &,tr"%!5 +en'an +e%&#$re! +ar! %&-&n ,a'!an +!ta- K&-&n ,a'!an $r&%!#a- a#$a! -eta% &,tr"%! a%an -e,!/ ,an)a% ,er!! (a!ran +ar!$a+a 6ee U" /a-" ,a'!an $r&%!#a- #"n'%!n ,er+!-ata!5 #"n'%!n *"'a t!+a% D"'aan t"#&r %&-&n +a$at +!,"at 6&t& ,ar!"# ene#a F&t& $&-& a,+&#en #e#$"n)a! t!n'%at en!t!!ta @@ $a+a &,tr"%! "" /a-"5 e+an'%an en!t!!ta 4 $a+a &,tr"%! %&-&n F&t& t/&ra% PA +!$er-"%an "nt"% #en'eta/"! a+an)a "+ara ,e,a )an' ter-eta% +! ,a8a/ +!a6ra'#a %anan )an' #en"n*"%%an a+an)a $er6&ra!
7T (an %a+an' < %a+an' +!'"na%an "nt"% #ene'a%%an +!a'n&a $a+a &,tr"%! "" /a-" "nt"% #en'!+ent!6!%a! $a!en +en'an &,tr"%! )an' %&#$-!t +an $a+a &,tr"%! "" ,ear )an' +!("r!'a! a+an)a a,e #a"$"n %e'anaan
VII. DIAGNOSIS BANDING
I-e" $ara-!t!%
Mer"$a%an "at" 'a8at a,+&#en ,er"$a +!ten! a,+&#en %arena "" t!+a% ,er%&ntra%! a%!,at a+an)a 'an''"an #&t!-!ta +! #ana $er!ta-t!% "" +!/a#,at
$er'era%an "" Man!6eta! %-!n!%n)a ,er"$a +!ten! $er"t5 t!+a% +a$at 6-at" #a"$"n +e6e%a! +an +a$at +!erta! #"nta/ erta $er"t teraa %e#,"n' Pa+a $e#er!%aan 6!!% +!te#"%an +!ten! a,+&#en5 ,!!n' "" #en"r"n ata" ,a/%an #en'/!-an'5 t!+a% ter+a$at n)er! te%an +an $er%"! t!#$an! +! e-"r"/ -a$an' a,+&#en Pa+a $e#er!%aan ra+!&-&'!5 6&t& $&-& a,+&#en +!+a$at%an 'a#,aran +!-ata! "" #en)e-"r"/ +ar! 'ater a#$a! re%t"# +an /err!n' ,&ne a$$earan(e 'a#,aran t"-an' !%an3
VIII. PENATALAKSANAAN
Daar $en'&,atan !-e" &,tr"%! a+a-a/ %&re%! %ee!#,an'an e-e%tr&-!t +an (a!ran5 #en'/!-an'%an $ere'an'an +an #"nta/ +en'an +e%&#$re!5 #en'ata! $er!t&n!t! +an )&% ,!-a a+a5 +an #en'/!-an'%an &,tr"%! "nt"% #e#$er,a!%!
%e-an'"n'an +an 6"n'! "" %e#,a-! n&r#a-
Re"!ta!
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O$erat!6
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1 Per!a$an Pra,e+a/
T!n+a%an +e%&#$re! +en'an $e#aan'an &n+e -a#,"n' NGT3 +an -a%"%an $en'!a$an (a!ran +an "+ara T!n+a%an !n! "nt"% #en(e'a/ #"nta/ +an a$!ra!
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2 Pe#,e+a/an
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ata "#,!-!%" +en'an (a%"$an #"-a! +ar! 'ar! ten'a/ a#$a! %"a+ar!an %anan ata Sete-a/ #e#,"%a %a"# a,+&#!na-5 +!-a%"%an !n$e%! +!+a-a#n)a "nt"% #en(ar! %e#"n'%!nan a+an)a %e-a!nan an&#a-! -a!nn)a Unt"% #en+a$at%an 'a#,aran -a$an' $an+an' )an' ,a!% $a+a $ar "$er!&r +"&+en"#5+en'an an'at /at!/at! +!-a%"%an $en''eeran /at! -!er3 e-an*"tn)a %&-&n aen+en +an 6-e%"ra (&-! +e%tra +!!n'%!r%an +en'an $er-a/an-a/an Ter+a$at +"a ,ent"% anat&#&! +"&+en+"&+en&t&#) )an' +a$ata+!!-a%"%an )a!t" ,ent"% 13 S!+e t& !+e +"&+en&t&#) +an 23 Pr&%!#a- traneret& +!ta- -&n'!t"+!na- D!a#&n+ S/a$e+ D"&+en&+"&+en&t&#)3
T!n+a%an &$era! D!a#&n+ S/a$e+ D"&+en&+"&+en&t&#) DSD3+!-a%"%an e,a'a! ,er!%"t
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Ne--at&n (ateter )an' %e(!- +!#a"%%an #e-a-"! "*"n' e'#en +!ta- )an' +!,"at 20 ?0 #- a-!ne /an'at +!!n*e%!%an
I. KOMPLIKASI
Da$at +!te#"%an %e-a!nan %&n'en!ta- -a!nn)a M"+a/ ter*a+! +e/!+ar!a!5ter"ta#a ,!-a t!+a% ter$aan' -!ne !ntraena Sete-a/ $e#,e+a/an5 +a$at ter*a+! %&#$-!%a! -an*"t
e$ert! $e#,en'%a%an +"&+en"# #e'a+"&+en"#35 'an''"an #&t!-!ta ""5 ata" re6-"% 'atr&e&6a'ea-Pene-!t!an La"ra K et a- 1JJ3 )an' +!-a%"%an ter/a+a$ J2 ne&nat" +en'an atre!a +"&+ena- T!$e I @45 T!$e II 15 T!$e III 13 +en'an #e-a%"%an t!n+a%an $e#,e+a/an D"&+en&+"&+en&t&#) @35 +"&+en&t&#) 8!t/ 8e, e(!!&n 3 an+ +"&+en&*e*"n&t&#) 35 +!+a$at%an %&#$-!%a! $&t&$erat!e P&t&$erat!e 7&#$-!(at!&n3 )a!t" 4 ne&nat" ?3 +en'an &,tr"%!5 (&n'et!e /eart 6a!-"re J35 !-e" $ara-!t!% )an' ,er%e$an*an'an 435$ne"#&n!a 35 !n6e%! -"%a "$er6!!a-! ?3 K&#$-!%a! -an*"t ter#a"% $er-e%atan &,tr"%! "" J35 +!#&t!-!ta +"&+ena- -an*"t )an' #en'/a!-%an #e'a+"&+en"# )an' #e#,"t"/%an +"&+en&$-at) 435 +an 'atr&e&$/a'ea- re6-"% +!eae )an' t!+a% re$&n +en'an $en'&,atan +an #e#,"t"/%an $e#,e+a/an ant!re6-"% N!en F"n+&$-!(at!&n S"r'er)3
3
Stran'"-a! #en*a+! $en)e,a, +ar! %ea,an)a%an %a" %e#at!an a%!,at &,tr"%! "" I! -"#en "" #er"$a%an (a#$"ran ,a%ter! )an' #e#at!%an5 /a!-/a!- $r&+"%! ,a%ter!5 *ar!n'an ne%r&t!% +an +ara/ U" )an' #en'a-a#! tran'"-a! #"n'%!n #en'a-a#! $er6&ra! +an #en''e-"ar%an #ater! tere,"t %e +a-a# r&n''a $er!t&ne"# Teta$! #e%!$"n "" t!+a% #en'a-a#! $er6&ra! ,a%ter! +a$at #e-!nta! "" )an' $er#ea,e- tere,"t +an #a"% %e +a-a# !r%"-a! t","/ #e-a-"! (a!ran 'eta/ ,en!n' +an
#en'a%!,at%an /&(% e$t!%
. PROGNOSIS
M&r,!+!ta +an #&rta-!ta te-a/ #e#,a!% e(ara ,er#a%na e-a#a 0 ta/"n tera%/!r Den'an a+an)a %e#a*"an +! ,!+an' anete! $e+!atr!%5 ne&nat&-&'!5 +an te%n!% $e#,e+a/an5 an'%a %ee#,"/ann)a te-a/ #en!n'%at /!n''a J0
M&rta-!ta !-e" &,tr"%t!6 !n! +!$en'ar"/! ,an)a% 6a%t&r e$ert! "#"r5 et!&-&'!5 te#$at +an -a#an)a &,tr"%! C!%a "#"r $en+er!ta an'at #"+a ata"$"n t"a #a%a t&-eran!n)a ter/a+a$ $en)a%!t #a"$"n t!n+a%an &$erat!6 )an' +!-a%"%an an'at ren+a/
e/!n''a #en!n'%at%an #&rta-!ta Pa+a &,tr"%! %&-&n #&rta-!tan)a -e,!/ t!n''! +!,an+!n'%an &,tr"%! "" /a-"
O,tr"%! "" /a-" )an' t!+a% #en'a%!,at%an tran'"-a! #e#$"n)a! an'%a %e#at!an Ke,an)a%an $a!en )an' #en!n''a- a+a-a/ $a!en )an' "+a/ -an*"t "!a O,tr"%! "" /a-" )an' #en'a-a#! tran'"-a! #e#$"n)a! an'%a %e#at!an e%!tar *!%a &$era! +!-a%"%an +a-a# *an'%a 8a%t" ?@ *a# e"+a/ t!#,"-n)a 'e*a-a'e*a-a5 +an 2 *!%a &$era! +!"n+"r%an -e,!/ +ar! ?@ *a#
