PENUTUPAN LUKA LAPARATOMI YANG KOTOR AKIBAT PERITONITIS DIFUSE E.C. TYPHOID PERFORASI DENGAN MENGGUNAKAN BENANG SINTETIK ABSORBABLE MONOFILAMENT

PENUTUPAN LUKA LAPARATOMI YANG KOTOR

AKIBAT PERITONITIS DIFUSE  E.C. TYPHOID PERFORASI

DENGAN MENGGUNAKAN BENANG

SINTETIK ABSORBABLE MONOFILAMENT

DI RSUD. ARJAWINANGUN, CIREBON, JAWA BARAT

DI SUSUN OLEH:

Dr. HERRY SETYA YUDHA UTAMA, SpB, FInaCS, MHKes. ICS

www.dokterbedahherryyudha.com

RUMAH SAKIT UMUM DAERAH ARJAWINANGUN

CIREBON – JAWA BARAT

INDONESIA

ABSTRACT

Telah dilakukan penelitian selama 11 tahun mengenai penutupan luka laparatomi yang kotor akibat peritonitis disfuse e.c. typhoid perforasi dengan  menggunakan benang synthetic absorbable monofilament di Rumah Sakit Umum Daerah Arjawinangun, Cirebon, Jawa Barat, Indonesia.

Didapat 96 kasus, dimana 50 kasus di jahit dengan Continous Mass Closure tanpa diperkuat (Jenkins Metoda CMC) dan 46 kasus dijahit dengan Continous Mass Closure diperkuat dengan Smead Jones Metoda (CMCSJ)

Dari 50 pasien yang di jahit CMC, 7 (tujuh) orang pasien (14%) mengalami infeksi luka operasai. 2 (dua) orang pasien (4%) mengalami Granuloma benang, 1 (satu) orang pasien (2%) terjadi Hernia Incisional dan tidak ada yang Burst Abdomen.

Dari 46 (empat puluh enam) orang pasien yang dijahit dengan CMCSJ ternyata, ada 10 (sepuluh) orang pasien (21,7%)yang mengalami Granuloma benang, tidak satu orang pasien pun yang mengalami Hernia atau pun Burst Abdomen.

DIFFUSE PERITONITIS DUE TO TYPHOID PERFORATION

CHAPTER I

INTRODUCTION
Typhoid fever is a systemic disease caused by Salmonella typhi. The disease is characterized by prolonged heat, the prop with bacteremia without getting involved or endokardial endothelial structure and invasion of bacteria into the cell multiplication as well as mononuclear phagocytes of the liver, spleen, lymph nodes and intestinal Peyer's patches. Until now, typhoid fever remains a public health problem, and associated with poor sanitation, especially developing countries.
In developing countries, the estimated incidence of typhoid fever varies from 10 to 540 per 100,000 population. Although the incidence of typhoid fever came down with a sanitary disposal in many developing countries, estimated that each year there are 35 million cases with 500,000 deaths in the world there. Typhoid fever in Indonesia is still an endemic disease with an incidence rate is still high. Among the diseases that are categorized as intestinal infectious diseases, typhoid fever ranks second after gastroenteritis. 1
Gastrointestinal perforation is a complex form of penetration of the wall of the stomach, small intestine, large intestine result from leakage of intestinal contents into the abdominal cavity. Perforation of the colon can potentially lead to the occurrence of bacterial contamination in the abdominal cavity (a condition known as peritonitis). Gastric perforation developed into a chemical peritonitis caused by leakage of stomach acid kedlam abdominal cavity. Perforation in any form of gastrointestinal distress is a surgical case. 3
In children, injury to the small intestine caused by blunt abdominal trauma from a very rare with 1-7% incidence. Since 30 years ago merupakn peptic ulcer perforation in a common cause. Perforated duodenal ulcer incidence is 2-3 times more than a perforated gastric ulcer. Nearly 1/3 of gastric perforation due to gastric malignancy. Approximately 10-15% of patients with acute diverticulitis can develop into free perforation. In the older patients had a mortality rate of appendicitis acuta as much as 35% and 50% morbidity. The main factors that contribute to morbidity and mortality in these patients is a severe medical conditions that accompany such appedndicitis.
Perforation of the gastrointestinal tract is often caused by diseases such as gastric ulcer, appendicitis, gastrointestinal malignancies, diverticulitis, superior mesenteric artery syndrome, trauma. 2

DIAGNOSTICS APPROACH TO ACUTE ABDOMEN

INTRODUCTION

To understand the meaning of the term "acute abdomen" indicating that an abnormality nontraumatik spontaneous and suddenly the main manifestations in the abdominal region with the main symptom is usually pain. may require operative measures when more than 6 hours duration .. Because usually the cause of intra-abdominal abnormalities are progressive, it is not good late in the diagnosis and treatment because of worsening outcomes.
Step approach to patients with acute abdominal condition must be carefully and thoroughly. Allegation of suspected acute abdomen should remain even if patients only have mild symptoms and atypical. History and physical examination performed to find probable cause and directs the option to set the primary diagnosis. A clinician then decides if the observation at the hospital to ensure that if additional inspection is required, if the initial surgery is indicated, or if the treatment is more operatif.
Obligation of the clinician must carefully identify the onset of symptoms of the most common cause of general acute abdomen. What's more, they must recognize the specific symptoms of the disease in endemic areas and where they practice.
Common cause of acute abdomen
A. Gastrointestinal tract
- Abdominal pain nonspecific
- Appendicitis
- Obstruction of the small intestine and colon
- Perforation of the peptic ulcer
- Hernia inkarserata
- Perforation of the intestine
- Diverticulitis

2. Liver, spleen and gall
- Acute kolesistisis
- Acute kholangitis
- Liver Abscess
- Acute Hepatitis
- Infrak spleen
3. Pancreas
- Acute pancreatitis
4. Urinary tract
- Renal colic
- Acute pyelonephritis
5. Gynecology
- Acute salpingitis
- A ruptured ectopic pregnancy
6. Vascular
- Acute ischemic colitis
- Mesenteric thrombosis
7. Peritoneum
- Intra-abdominal abscess
- Peritonitis tuberculosis
8. Retroperitoneum
- Bleeding retroperitoneum

we must know about :

Diagnosis and Management Tuberculosis Peritonitis with Intestinal Obstruction

Introduction
Tuberculosis is still an endemic disease that is quite worrying in Indonesia. From the existing data that Indonesia occupied the position-3 in the world after China and India. However, for the discovery of new cases in recent years Indonesia occupied the fifth position after China, India, Philippines and Thailand. This does not necessarily indicate that tuberculosis has been declining in Indonesia, probably many factors that cause yain. Because of Indonesia's total population is pretty much (pulmonary tuberculosis), then the extra-pulmonary tuberculosis were also many in Indonesia, especially nutritional status in Indonesia is still not good.

A. Definition
Peritoneal tuberculosis is an inflammation of the parietal or visceral peritoneum caused by the bacteria Mycobacterium tuberculosis, and the disease is also frequently seen on the entire peritoneum, gastrointestinal system tools, mesentery and internal organs genetalia

B. Incidence
Peritoneal tuberculosis is more common in women than men with a ratio of 1.5:1, and more often decades to 3 and 4. Peritoneal tuberculosis found 2% of all pulmonary tuberculosis and 59.8% of abdominal tuberculosis. In the United States this disease is the sixth largest among extra pulmonary disease, while other researchers found that only 5-20% of patients with peritoneal tuberculosis who have active pulmonary TB. At this time it was reported that cases of peritoneal tuberculosis in developed countries is increasing and this increase is in accordance with the increasing incidence of AIDS in developed countries. 1
She Asia and Africa where tuberculosis is still prevalent, peritoneal tuberculosis is still an important issue. Manohar et al reported on King Edward III Hospital Durban South Africa found 145 cases of peritoneal tuberculosis over a period of 5 years (1984-1988) while peritonoskopi way. Daldiono find as many as 15 cases at Cipto Mangunkusumo Hospital in Jakarta during the period 1968-1972 and Solomon in the same hospital period 1975-1979 found a total of 30 cases of peritoneal tuberculosis was also Sibuea et al reported there were 11 cases of peritoneal tuberculosis in hospital for a period Tjikini Jakarta 1975 to 1977. Whereas in Medan Zain LH reported there were 8 cases during the period 1993-1995.

C. Pathogenesis
Peritoneal tuberculosis can be subjected by a number of ways:
A. Through haematogenous spread mainly from lung
2. Through the intestinal wall of infected
3. From mesenteric lymph nodes
4. Through the fallopian tubes are infected
In most cases of peritoneal tuberculosis occurs not as a result of the spread perkontinuitatum but often due to reactivation of latent processes that occur in the peritoneum obtained through previous haematogenous spread of the primary process (latent infection "Dorman infection"). As is known to have tuberculosis lesion suppression and healing. Still in the latent phase of infection where it can persist throughout life, but latent infection can develop into tuberculosis had at any time. If the organ was started bermutiplikasi intrasseluler quickly.