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circulation (ABCs).
using a long tube (nasointestinal) instead of a short tube (NG) has been observed.
obstruction occurs in virtually all patients with these lesions within 72 hours. Good
partial SBO cases without peritonitis. [10, 13] Nonoperative treatment for several
obstruction
Incarcerated hernia: Initially use manual reduction and observation; advise elective
often are attributed to incisional pain and postoperative ileus; treatment should be
nonoperative
adhesion formation
Studies have evaluated the use of WSCM as a tool in the management of SBO and
not cause resolution of the SBO, WSCM may reduce the hospital stay in patients not
requiring surgery.
However, a more recent systematic review that analyzed retrospective data (2006-
2009) from 242 patients in 10 studies with uncomplicated acute adhesive SBO
reducing the need for surgical intervention (24% vs 20%, respectively) or bowel
resection (8% and 4%). Results were similar for both groups with respect to the time
interval between the initial CT scan and surgery, as well as the time interval between
oral refeeding and discharge. [28] The sole potential risk factor for failure of
Surgical Care
small-bowel obstruction (SBO), the risk of strangulation is high and early surgical
nonoperative trials fail also need surgical treatment but experience no apparent
Laparoscopy has been shown to be safe and effective in selected cases of SBO. [6, 7]
results in terms of hospital stay and mortality reduction versus open surgery, but
prospective, randomized, controlled trials to assess all outcomes are still needed. [29]
relatively high risk for mobidity and mortality. [30] In a retrospective study (2012-
2015) of 2233 patients who underwent surgery for bowel obstruction, those with
malignant bowel obstruction had a 14.5% adjusted mortality rate and a 32.2%
below 3.5 g/dL, hematocrit below 30%, cirrhosis, ascites, and urinary tract infection.
[30] https://emedicine.medscape.com/article/774140-treatment#showall
whether SBO is partial (some flatus) or complete (no flatus/no air in rectum on
present).
In general:
Patients with partial SBO may benefit from nasogastric decompression and close
observation.
Early surgical consultation with a general surgeon should take place. Operative
Correction of the underlying cause will be required for treatment of the concomitant
intestinal obstruction.
All patients
Non-operative treatment
emetics are generally not administered as they do not provide significant relief. The
anti-emetic may be beneficial, but only if nasogastric aspirates are minimal. [13]
is needed.
will a complete SBO respond to non-operative therapy, and for this reason, surgery
In cases where surgery is deemed not to be in the patient’s best interests, such as
where the SBO is due to advanced malignancy, the focus of treatment should be on
adequate analgesia.
Correction of the underlying cause will be required for treatment of the concomitant
Ladd procedure for malrotation, tumour resection for obstructing tumour, and hernia
repair for inguinal hernia should be performed when diagnosed. The most frequent
surgery is present.
treatment
Operative treatment
The nature of the obstruction determines the type and extent of surgery. Exploratory
In patients with complete SBO, peritonitis will develop in time if not already present.
For this reason, early surgical intervention is crucial whenever complete SBO is
Antibiotic prophylaxis
Patients undergoing surgery for SBO will require broad-spectrum antibiotics (e.g.,
Acute
Patient group
Treatment line
Treatmenthide all
1st
Peritonitis will develop in time if not already present; for this reason early surgical
infection.
Primary options
and
1 mg/kg 8 hours later; adults: 1.5 mg/kg intravenously 30 minutes before surgery,
OR
cefoxitin: children >3 months of age: 30–40 mg/kg intravenously 30-60 minutes
before surgery, followed by 30-40 mg/kg every 6 hours for 24 hours; adults: 1-2 g
intravenously 30-60 minutes before surgery, followed by 1-2 g every 6-8 hours for
24 hours
plus
strategy.
Primary options
morphine sulfate: children: 0.1 mg/kg intravenously every 3-4 hours when required;
plus
Correction of the underlying cause will be required for treatment of the concomitant
intestinal obstruction.
malrotation (infants), tumour resection for obstructing tumour, and hernia repair for
1st
In cases where surgery is deemed not to be in the patient's best interests (e.g., SBO is
upper GI tract.
intravenous fluid (either lactated Ringer or normal saline) to resuscitate and maintain
plus
analgesics
morphine sulfate: children: 0.1 mg/kg intravenously every 3-4 hours when required;
adjunct
anti-emetics
Primary options
adjunct
antispasmodics
partial SBO
1st
fluid resuscitation plus nasogastric decompression
GI tract.
Fluid replacement and passage of a nasogastric tube result in the correction of partial
plus
Correction of the underlying cause will be required for treatment of the concomitant
Ladd procedure for malrotation (infants), tumour resection for obstructing tumour,
and hernia repair for inguinal hernia should be performed when diagnosed.
The most frequent causes include adhesions, inguinal hernia, or tumour in adults in
plus
Primary options
morphine sulfate: children: 0.1 mg/kg intravenously every 3-4 hours when required;
plus
laparotomy
plus
infection.
Primary options
and
gentamicin: children: 2 mg/kg intravenously 30 minutes before surgery, followed by
1 mg/kg 8 hours later; adults: 1.5 mg/kg intravenously 30 minutes before surgery,
OR
cefoxitin: children >3 months of age: 30-40 mg/kg intravenously 30-60 minutes
before surgery, followed by 30-40 mg/kg every 6 hours for 24 hours; adults: 1-2 g
intravenously 30-60 minutes before surgery, followed by 1-2 g every 6-8 hours for
24 hours
plus
Correction of the underlying cause will be required for treatment of the concomitant
Ladd procedure for malrotation (infants), tumour resection for obstructing tumour,
and hernia repair for inguinal hernia should be performed when diagnosed. The most
practice/monograph/993/treatment/details.html
KOMPLIKASI 1,2
Komplikasi obstruksi ileus tergantung pada beratnya kondisi, usia pasien, adanya
penyakit yang menyertai dan seringkali juga dipengaruhi durasi gejala yang muncul,
yaitu:
1. Nekrosis intestinum
Pada pasien yang tidak terobati secara komprehensif, kemungkinan terjadi
intestinum menurun yang mengakibatkan perubahan iskemik dan nekrosis. Hal ini
diperparah dengan onset peritonitis, leukositosis, dehidrasi, dan gagal ginjal pre-
renal.
2. Sepsis
Pasien yang menderita nekrosis intestinum yang diobati atau tidak diobati maupun
menyebabkan kematian.
3. Abses intra-abdominal
Jika terjadi obstruksi intestinum yang disertai perforasi, pasien dapat mengalami
intestinum atau akibat dari multiple surgery, pasien dapat mengalami short bowel
syndrome. Hal ini diketahui dengan kehilangan fungsi maupun anatomi pada
PENCEGAHAN3,4
Selain itu, menurut Alberta Health Service, pencegahan small bowel obstruction
Oktober 2017.
http://bestpractice.bmj.com/best-practice/monograph/993/follow-
3. PA Ramani, Rao KJ, Chinth JR, Prakash GR, Krishna KS (2016). Evaluation of
http://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-eating-well-to-
obstruction after abdominal surgery, best surgical practice may minimise their
formation. [6] There are a variety of agents designed to limit the extent of
of SBO due to intestinal volvulus. [8] Treatment of Crohn's disease and surgical
correction of hernias can also limit its development. One of the potential
subgroups of patients having surgery for cancer and diverticular disease. [9]
Oktober 2017.
http://bestpractice.bmj.com/best-practice/monograph/993/follow-
PENCEGAHAN
obstruction after abdominal surgery, best surgical practice may minimise their
formation. [6] There are a variety of agents designed to limit the extent of
of SBO due to intestinal volvulus. [8] Treatment of Crohn's disease and surgical
correction of hernias can also limit its development. One of the potential
advantages of laparoscopic compared with open colorectal surgery is a reduction
subgroups of patients having surgery for cancer and diverticular disease. [9]
PENATALAKSANAAN
1. Persiapan
Pipa lambung harus dipasang untuk mengurangi muntah, mencegah aspirasi dan
dilakukan juga resusitasi cairan dan elektrolit untuk perbaikan keadaan umum.
2. Operasi
Operasi dapat dilakukan bila sudah tercapai rehidrasi dan organ-organ vital
Pengobatan pasca bedah sangat penting terutama dalam hal cairan dan elektrolit.Kita harus
mencegah terjadinya gagal ginjal dan harus memberikan kalori yang cukup.Perlu diingat bahwa