radiologi invaginasi

7/23/2019 radiologi invaginasi

1/23

Pembimbing:dr. Budi Rahayu, Sp.Rad

Ahmad Ramdoni C

Chong Wei Hern

INTUSSUSCEPTION


2/23

Seorang anak perempuan umur 2 tahunberinisial R datang ke IGD RSUD Slemandengan keluhan BAB berdarah dan nyerisaat buang air besar.

Contoh Kasus


3/23

Intususepsi adalah masuknya segmenusus proksimal ke rongga lumen usu

yang lebih distal sehingga

menimbulkan gejala obstruksi

berlanjut strangulasi usus.


4/23

Definition

Invagination or prolapse of a segment of

intestinal tract (= intussusceptum)

into the lumen of the adjacent intestine

(= intussuscipiens)


5/23

Klasifikasi

Enterik = usus halus ke usus halus

Ileosekal = valvula ileosekal mengalami

invaginasi ke caecum.

Colocolika = Colon ke colon.

Ileocolika = ileum prolaps melalui valvula

ileosekalis ke colon.


6/23

90% kejadian tersering adalah

ileocolic

Biasa terjadi di 2 tahun umur awalkehidupan.

Laki-laki 3 kali lebih sering daripada

wanita.


7/23

Patofisiologi

Gangguan motilitas usus yang terdiri dari duakomponen yaitu satu bagian yang bergerakbebas dan dan satu bagian usus lainnya yang

terfiksir. Karena arah peristaltik adalah dariarah oral ke anal maka bagian yang masuk kearah lumen usu adalah bagian proksimal/oral.Sehingga menyebabkan dinding usus terjepit

dan mengakibatkan aliran darah menurun danmenyebabkan nekrosis dinding usus,obstruksidan edema.


8/23

Etiology and Pathophysiology

Secondary to imbalance in the longitudinalforces along the intestinal wall.

This imbalance can be caused by a mass acting

as a lead point or by a disorganised pattern ofperistalsis.

Causing the intestine to invaginate into the

lumen of adjacent bowel. Early in the process, lymphatic return is

impeded then with increased pressure within

the wall of the intussusceptum, venous

draina e is im ared


9/23

Obstructive process continues, pressure

reaches a point where arterial inflow is

inhibited and infarction occurs.

Example of lead points: meckel diverticulum,

enlarged mesenteric lymph node, benign or

malignant tumor of the mesentery of the

intestine, mesenteric or duplication cyst,submucosal hematoma.


10/23

Etiologi

no pathological lead point

associated with lymphoidhyperplasia in Peyers patches of the

ileum

90%

lead point

Meckels diverticulum (mostcommon lead point) polyp or othertumour duplication cyst

10%


11/23

Etiologi

Pemijatan perut

Pemberian obat anti diare

Infeksi rotavirus


12/23

Trias Invaginasi

Anak mendadak kesakitan episodic, menangis

dan mengangkat kaki( craping pain ).

Muntah warnah hijau ( cairan lambung)

Defekasi feses campur lendir dan darah.


13/23

Pemeriksaan Fisik

Obstruksi mekanis yang ditandai darmsteifung dan darm counter,

Teraba massa seperti sosis di daerah subcostal

yang terjadi spontan. Nyeri tekan (+)

Dancen Sign (+) sensasi kekosongan pada

kuadran kanan bawah karena masuknyacaecum pada kolon ascenden

RT : Pseudoportio (+) dan Lendir darah (+)


14/23

Radiology Features

film is normal in 50%

A soft-tissue mass or intraluminal fillingdefect, in a partially air-filled bowel loop(commonly at hepatic flexure),may be seen.

AXR

a target sign may be seen, appearing as concentricalternating echogenic and echo-poor rings, representingcompressed mucosal and serosal surfaces and oedematous

bowel wall, respectively. Colour Doppler shows blood vessels dragged in between the

entering and exiting layers of the intussusception. Absence ofblood flow indicates devitalised bowel segments.

USS


15/23

contraindicated in perforation.

May show a coiled spring appearance witha beak-like distal string of barium as it runs

through the central column.

Antegradebarium

study

contraindicated in perforation.

Water soluble contrast enemas may demonstrate a

convex intraluminal mass, representing theintussusceptum, surrounded by contrast. The coiledspring sign is seen as contrast flows over the

oedematous fold of the reflected intussusceptum.

Bariumenema


16/23


17/23

Three-year-old boy with abdominal

pain and lower GI tract bleeding.

Plain abdominal radiograph shows

the presence of a soft tissue mass

in the central abdomen outlined on

its left side by air within the large

bowel (arrow). This finding is

suspicious for an intussusception.


18/23

Intussusception. Soft tissue density mass within the upper abdomen (arrowheads).


19/23

Ring Sign/Doughnut

Sign/Pseudokidney Sgn


20/23

Diagnostics. Plain

abdominal radiograph is

only indicated in unclear

diagnosig only late specific

signs of abdominal gas

distribution or faecal

contents and, finally, signs

of bowel obstruction s,

showinor perforation. In

retrograde barium enemaformerly used, the contrast

medium is outlining the

apex of the

intussusceptum.


21/23

Treatment

Barium enema and air enema

For diagnostic and therapeutic.

Contraindication: strangulated bowel, perforation, ortoxicity are present.

Care is required in performing either air or barium enemabecause ischemic damage to the colon secondary tovascular compromise increases the risk of perforation.

Surgery

contraindicate to barium enema therapy identifying a lead point such as a Meckel diverticulum

lower recurrence rate than pneumatic reduction.


22/23

Complications Of

Intussusception

necrosis

perforation

obstruction


23/23

Conder, G., A to Z Abdominal Radiology.

Cambridge: 2009.

Hillwarth, M. E. Pediatric Surgery, Austria:

Springer, 2006.

Daldrude, H., Essential of Pediatric Radiology.

Cambridge, 2010.

Eastman, G., Getting Started in Clinical

Radiology. Newyork: Thiemme. 2006

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