Bagian Ilmu Bedah Digestif
Journal Reading
Fakultas Kedokteran
Mei 2015
Universitas asanuddin
ETIOLOGI PERITONITIS DAN FAKTOR PENYEBAB KEMATIAN PADA PASIEN PERITONITIS
Disusun oleh! Fikri Rifa amdi "1111015#
$em%im%ing Residen! dr& 'hmadi 'l(i
)u*ervisor! Dr& dr& dr& Ronald +& ,usikoo-. )*B/KBD
DEPARTEMEN DEPARTEMEN ILMU BEDAH FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN MAKASAR 2015
LEMBAR PENGESAHAN Yang beran!aangan !" ba#a$ "n"% Na&a
% F"'r" R"(a Ha&!"
NIM
% )111 10 15*
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% E".-.g" Per".n""/ Dan Fa'.r Penebab Ke&a"an Pa!a Pa/"en Per".n""/
Te-a$ &ene-e/a"'an ,ga/na !a-a& rang'a 'ean"eraan '-"n"' !" Bag"an I-&, Be!a$ /,b!""/" I-&, Be!a$ D"ge/"( Fa',-a/ Ke!.'eran Un"er/"a/ Ha/an,!!"n3 Ma'a//ar4 Me" 2015
Pe&b"&b"ng Re/"!en
Dr3 A$&a!" A-#"
S,er"/.r
Dr3 R.na-! E3 L,/"'..4 SBKBD
ETIOLOGI PERITONITIS DAN FAKTOR PENYEBAB KEMATIAN PADA PASIEN PERITONITIS Jeetendar J $ar-ani. ikas $atel. unvant Rathod 'B)R'K $endahuluan! Per".n""/ a!a-a$ '.n!"/" 'ega#a!ar,raan be!a$ ang &e&b,,$'an enanganan be!a$ /e6ara 6ea !an ."&a-3 T,7,an !ar" ene-""an "n" a!a-a$ ,n,' &en7e-a/'an erbe!aan (a'.r re!"/./"/" ang !aa berengar,$ er$a!a r.gn./"/ a/"en3 Metode *enelitian! Seb,a$ ene-""an rer./e'"( ang &enga&b"- !aa re'a& &e!"' r,&a$ /a'" er$a!a 80 a/"en ang &en7a-an" -aar..&" ,n,' enaganan er".n""/ !a-a& renang #a', b,-an +an,ar" !an Febr,ar" 2012 !" )""- H./"a- !an B3+ Me!"6a- ).--age asil! Dar" 80 a/"en4 /ebana' 18 !" anarana &en"ngga- 9284*:;3 E".-.g" er/er"ng a!a-a$ er(.ra/" e"' 950:;< 'e&a"an erbana' 7,ga !"/ebab'an .-e$ er(.ra/" e"' 9= a/"en !ar" 18 a/"en4 50:;3 Fa'.r ang &e&erb,r,' !" anarana a!a-a$ ,/"a4 er-a&ba !"ba#a 'e r,&a$ /a'"4 a'"'ar!"4 $".en/"4 /e"'e&"a4 !an en,r,nan (,ng/" g"n7a-3 Kesim*ulan! Ang'a 'e&a"an a!a er".n""/ 9284*:; a!a-a$ ang'a ang 6,', "ngg"3 Ter-a&ba !"ba#a 'e r,&a$ /a'" &er,a'an enebab a-"ng en"ng !a-a& erb,r,'an '.n!"/" a/"en3 Ta'"'ar!"4 $".en/"4 gaga- g"n7a-4 !an /e"'e&"a a!a-a$ (a'.r en"ng ang /e6ara /"gn"("'an !a-a& &e&re!"'/" 'e&a"an 9&a/"ng&a/"ng /"gn"("'an a!a 1:;3 Ke&,!"an4 7"'a a/"en er".n""/ !aa !"!ee'/" !"n" &e&"-"'" ge7a-a /eer" !" aa/ !an &en!aa enanganan ang 6ea4 'e&a"an !aa !"6ega$3 Ke-(ords! Per".n""/4 Per(.ra/" Pe"'4 Ta'"'ar!"4 H".en/"
$+3D'U,U'3
Per".n""/ a!a-a$ "n(-a&a/" a!a er".ne,& ang b"a/ana !"/ebab'an 'arena "n(e'/" genera-"/aa aa, -.'a-"/aa3 Per".n""/ er!"r" !ar" er".n""/ r"&er !an /e',n!er3 Per".n""/ er"&er 7arang &e&b,,$'an enanganan be!a$3 Per".n""/ /e',n!er !aa !"/ebab'an .-e$ er(.ra/" a!a ,/,/ ang &enebab'an r.ngga er".ne,& er'.na&"na/" !engan "/" ,/,/ !an '.-.n" ba'er" ang bergan,ng a!a -.'a/" er(.ra/"3 Ha- ", &enebab'an er7a!"na 'e$"-angan 6a"ran /e6ara 6ea !an /e/"/3 Me'an"/&e ,b,$ er$a!a re/.n era!angan &enebab'an -e,'./"./"/4 &e-ea/'an /".'"n !an &e!"a.r&e!"a.r "n(-a&a/"3 Fa'.r(a'.r er/eb, a'an &enebab'an /.' /e"' 'e"'a "!a' a!a enga#a/an3
Per".n""/ a!a-a$ 'ega#a!ar,raan be!a$ ang a-"ng ,&,& !" In!"a3 Me/'",n !"!,',ng !engan e'n"' be!a$ &.!ern4 era" an"b"."'4 !an (a/"-"a/ era#aan "nen/"(4 enaa-a'/anaan er".n""/ &en,n, engea$,an ang ea4 enga-a&an4 enaa-a'/anaan -an7, !an &.n".r"ng era"3 E".-.g" er(.ra/" !" In!"a berbe!a !engan negaranegara !" bara ang ,&,&na er".n""/ !"/ebab'an .-e$ er(.ra/" /a-,ran 6erna ba#a$ /eer" !"er"',-""/4 /e!ang'an er(.ra/" /a-,ran 6erna bag"an ba#a$ ,&,&na !"/ebab'an 'arena er(.ra/" e"'3 T"ngg"na ang'a &.rb"!"a/ !an &.ra-"a/ !"/ebab'an 'arena er-a&bana !a-a& &en!"agn./"/ ang !aa !"erba"'" .-e$ en"ng'aan era#aan &e-a-," 'e&a&,an ang -eb"$ ba"' !a-a& &engena-" !an &eng.ba" er".n""/3 O-e$ 'arena ",4 .b7e' ene-""an "n" a!a-a& ,n,' &enen,'an e".-.g"4 e&er"'/aan ("/"/ !an en,n7ang !an &en"-a" '.re-a/" er$a!a ang'a &.ra-"a/ a!a a/"en er".n""/3
M+4D) $engaturan studi! Pene-""an "n" !"-a','an !" r,&a$ /a'" /""- !an B3+ Me!"6a- ).--ege4 A$&e!aba! /ee-a$ &e&er.-e$ er">"nan !ar" '.&"e e"/3 $engum*ulan data! Pa/"en ang er!a(ar !" r,&a$ /a'" /""- A$&e!aba! ang &en7a-an" .era/" enanganan er".n""/ /e-a&a b,-an +an,ar" !an Febr,ar" 2012 e-a$ er!a(ar !a-a& ene-""an "n" /ee-a$ &en!aa'an "n(.r& 6.n/en3 Per".n""/ !"!e("n"/"'an /ebaga" ner" -.'aaa, genera-4 'e'a',an aa, ner" e'an -ea/3 Ka&" &ene-,/,r" r"#aa a/"en /e6ara rer./e'"( &e-a-," ,-a/an !ar" b,', -a.ran .era/" !an re'a& &e!"' a/"en3 Var"abe- ang !"g,na'an /eer" ,/"a4 ,&,r4 -a&ana ge7a-a4 angga- &a/,' r,&a$ /a'" !an angga- 'e-,ar r,&a$ /a'" aa, angga- 'e&a"an4 r./e!,r .era/"4 !an !"agn./"/ be!a$4 an!aan!a "a9&e-"," e'anan !ara$4 !en, na!"4 ernaa/an;4 angga- !an $a/"- $",ng !ara$ -eng'a !an USG ab!.&en 7"'a er!aa "n!"'a/"3 'nalisis data! Ka&" &eng$",ng !e/'r"/" /a"/"' er$a!a ar"abe- /eer" !"agn./"/ be!a$4 ,&,r4 .n/e ge7a-a4 $a/"-4 an!a "a- ang &e-"," e'anan /"/.-"' 9?100&&Hg4 100120&&Hg4 !an @120&&Hg;4 -a7, ernaa/an 9?0C&en"4 0C&en";4 !en, na!" 9?100C&en"4 100 120C&en"4 @120C&en";4 $",ng .a- 9?000C!L4 00012000C!L4 @12000C!L;4 'rea"n"n 9?145&gC!L4 145&gC!L;4 !an a!a aa, "!a'na 6a"ran beba/3 Var"abe- !" aa/ !"ban!"ng'an !a-a&!,a 'e-.&.'% &en"ngga- 9'e-.&.' A;4 !an bera$an 9'e-.&.' B;3
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Da-a& ene-""an "n"4 80 .rang .b7e' ene-""an erbag" !a-a& !,a 'e-.&.'% 'e-.&.' A &e-"," a/"en ang &en"ngga- 92*: 18 .rang !ar" 80 .rang; !an 'e-.&.' B ang &e-"," a/"en ang e-a$ !",-ang'an 9*: .rang !ar" 80 .rang;3 Raaraa ,&,r a/"en a!a-a$ 54542 !an a$,n !an baa/ ,/"ana a!a-a$ 10 a$,n3
Tabe- 1 &en,n7,''an ba$#a er(.ra/" e"' 950:; a!a-a$ e".-.g" er/er"ng !engan ang'a &.ra-"a/ ang "ngg" 9=C184 50:;3 Tabe2 &en,n7,''an (a'.r ang &e&engar,$" 'e&a"an3 U&,r !an .n/e a!a-a$ (a'.r ang /anga &e&engar,$" ang'a &.ra-"a/ /ebana' 5: 9040004 0400=;3 M.ra-"a/ &en"ng'a a!a 'aeg.r" ,&,r 420 a$,n< .n/e 2 $ar" &en"ng'a'an ang'a &.ra-"a/ 0 &en7a!" 8:3 Tan!a "a- 9HR4 BP4 RR; a!a-a$ (a'.r ang /"gn"("'an ang !aa &e&engar,$" ang'a &.ra-"a/3 Den, na!" @120C&en"4 e'anan !ara$ "/".-"' ?100&&Hg4 !an -a7, ernaa/an 0C&en" a!a-a$ (aa- a!a a/"en 9ang'a &.ra-"a/ &a/"ng&a/"ng 8*:4 =0:4 !an 8*:;3 T.a- $",ng !ara$ ?000C!L !an @12000C!L4 'rea"n"n 145&gC!L !an 6a"ran beba/ 7,ga &er,a'an (a'.r ang /"gn"("'an!a-a& &en"ng'a'an ang'a &.ra-"a/3
DI)KU)I
Per".n""/ a!a-a$ 'a/,/ ang a-"ng /er"ng !"7,&a" !" negara ber'e&bang /eer" In!"a3 Pa!a 'ebana'an 'a/,/4 'eer-a&baan &a/,' r,&a$ /a'" &en7a!" enebab er7a!"na er".n""/ genera-"/aa3 Ke&,!"an '.na&"na/" !ar" (e/e/ &enebab'an /e"'e&"a3 Tan!a !an ge7a-a '$a/ /anga &e&er&,!a$ !a-a& &enega''an !"agn./"/ '-"n"/ er".n""/ $a&"r 'e /e&,a a/"en3 Per(.ra/" ra',/ ga/r."ne/"na- r.'/"&a- /e6ara /"gn"("'an -eb"$ ,&,& !"ban!"ng'an !engan e".-.g" ang -a"n ,n,' ene-""an !ar" negara &a7, /eer" A&er"'a4 Y,nan"4 !an +eang ang e-a$ &eng,ng'a'an ba$#a er(.ra/" ra',r ga/r."ne/"na- ar/ !"/a- -eb"$ ,&,& er7a!"3 Ang'a 'e7a!"an er(.ra/" ,/,/ bag"an r.'/"&a- &en,r,n !" negara &a7, 'arena &enga!./" &ana7e&en era" He-"6.ba6er -.r"3 Ha- ", 'arena 'eer/e!"aan r..n ,& ang !aa &e&erba"'" ,-',/ !an &e&ban, &ene&b,$'an ,-',/ e"',/ /e$"ngga er7a!" en,r,nan ang'a 'e7a!"an ,-',/ e"',/3 Per(.ra/" ,/,/ bag"an !"/a- er,a&a er(.ra/" '.-.n !aa &enebab'an er".n""/ 'ebana'an negara bara3 E".-.g" !an -.'a/" er(.ra/" 7,ga &e&engar,$" r.gn./"/ a/"en3 Per(.ra/" ga/r.!,.!ena- er7a!" er,a&a 'arena er(.ra/" e"' ang ,&,&na &en7a!" enebab erbana' 'e&a"an a!a a/"en er".n""/ !" negara ber'e&bang3 Dan 7,ga4 e"' er(.ra/" -eb"$ bana' er7a!" !" 'e-.&.' ,&,r ,a3 Ab/e/ ab!.&"na- !an ne,&.n"a ang er7a!" ./ .era/" 7,ga bereran a!a &.rb"!"a/ !an &.ra-"a/3 Ter7a!"na r"/"'. "ngg" ne,&.n"a "n" !aa !"7e-a/'an !engan .era/" ab!.&"na- bag"an aa/3 Per(.ra/" a!a ra',/ ga/r."ne/"na bag"an r.'/"&a- 7"'a !"ban!"ng'an !engan er(.ra/" ra',/ ga/r."ne/"na- bag"an !"/a- 7,ga b"/a &en7a!" a-a/an -a"n er$a!a r.gn./"/ a/"en3 U&,r 7,ga &en7a!" (a'.r en"ng er$a!a r.gn./"/ a/"en4 a!a ,/"a ,a .-eran/" ,b,$ er$a!a er".n""/ ber',rang ang !",n7,''an !a-a& ene"-""an "n" er!aa ang'a &.ra-"a/ ang "ngg" a!a 'e-.&.' ,/"a ,a er/eb,3 Baa/ a&bang ("/".-.g" a!a ,/"a ,a &en"ng'a a!a (,ng/" 'ar!".a/',-ar4 ernaa/an !an g"n7a-3 Fa'.r '.&.rb"! "n" !aa er-$a a!a !,a er"ga a/"en3 H".en/" !an a'"'ar!" 7,ga &en7a!" "n!"'a/" b,r,'na r.gn./"/ 'arena er7a!"na en,r,nan er(,/" 7ar"ngan3 Ha- "n" ang &enebab'an e(e'"("a/ &ana7e&en re .era"( a!a a/"en "n" &en,r,n !an berengar,$ er$a!a r.gn./"/ a/"en3 Se"'e&"a 9T)?000C!L aa, @12000C!L; &eng"n!"'a/"'an ba$#a a!a a/"en er".n""/ !engan /e"'e&"a a'an er7a!" $"er'aab.-"/&e ang 'e&,!"an a'an &en"ng'a'an ang'a 'e&a"an3 Yang a-"ng en"ng !ar" /e&,a ", a!a-a$ a/"en 'a&" -eb"$ bana' ang er-a&ba &a/,' r,&a$ /a'" 9.n/e -eb"$ !ar" 2 $ar"; /e$"ngga $araan $"!, /e&a'"n ber',rang ang 'e&,!"an ber,7,ng a!a 'e&a"an4 ba"' &ere'a &engaba"'an ge7a-a aa, /,!a$
&en!aa'an enanganan &e!"/ a#a- !" (a/"-"a/ 'e/e$aan -.'a- 9/eer" ,/'e/&a/;4 aa, -.'a/" er$a!a ,n" (a/"-"a/ be!a$ ang 7ara'na 7a,$ /e$"ngga $ar,/ &ene&,$ er7a-anan 7a,$ ,n,' &en6aa" ,/a r,7,'an3 Ter-a&ba &a/,' r,&a$ /a'" 7,ga &en7a!" /a-a$ /a, enebab a/"en er".n""/ &en7a!" /e"'e&"a4 &enebar -,a/ /e6ara /"/e&"' ang 'e&,!"an &enebab'an '.n!"/" "n" /,-" !"'.nr.- !an &en,r,n'an $a/"- "nra.era/"3 Ha- "n" ang !"angga &en7a!" (a'.r a-"ng en"ng er$a!a a/"en !engan er".n""/ er,a&a ang !"/ebab'an .-e$ er(.ra/" e"'3 Pene-""an ang a'an !aang b"/a !"-a','an ,n,' &engea-,a/" aa'a$ '.re'/" er$a!a (a'.r(a'.r re .era/" ang !"/eb,'an !" aa/ /e6ara /"gn"("'an berengar,$ er$a!a 'e-ang/,ngan $"!, a/"en ang !aa !"-a','an !engan &e&ban!"ng'an !aa !ar" r,&a$ /a'" e&er"na$ ,/a !an r,&a$ /a'" /#a/a !" er"(er3
K+)IM$U,'3
Per".n""/ a!a-a$ 'ega#a!ar,raan be!a$ ang a-"ng ,&,& !" !eare&en be!a$3 Keer-a&baan &a/,' r,&a$ /a'" /e6ara /"gn"("'an &en7a!" (a'.r ,a&a en"ng'aan ang'a &.ra-"a/3 Ea-,a/" ra .era/"4 &ana7e&en $.&e./a/"/4 e&be!a$an /e6eana4 !an e&ana,an a/'a.era/" &en7a!" ',n6" ,a&a !a-a& &en,r,n'an &.ra-"a/ a/'a.era/" a!a a/"en er".n""/3
