SALURAN CERNA

I GEDE SUWEDAGATHA
TRAUMA CENTRE RS SANGLAH
Cleft lip
 Cleft lip and palate
Cleft lip (cheiloschisis) and cleft palate
(palatoschisis) (colloquially known as harelip),
which can also occur together as cleft lip and
palate, are variations of a type of clefting
congenital deformity caused by abnormal facial
development during gestation. Note that harelip
is now considered as a derogatory term. A cleft
is a fissure or opening -- a gap. It is the non-
fusion of the body's natural structures that form
before birth.
 Causes of cleft

The cause of cleft lip and cleft palate formation

can be genetic in nature.
Environmental influences may also cause, or
interact with genetics to produce, orofacial
clefting. Some environmental factors that have
been studied include: seasonal causes (such as
pesticide exposure); maternal diet and vitamin
intake; retinoids- which are members of the
vitamin A family; anticonvulsant drugs; alcohol;
cigarette use; nitrate compounds; organic
solvents; parental exposure to lead; and illegal
drugs (cocaine, crack cocaine, heroin, etc).
 Diagnosis

Traditionally, the diagnosis is made at the

time of birth by physical examination.
Recent advances in prenatal diagnosis
have allowed obstetricians to diagnose
facial clefts in utero.
 Treatment
Cleft lip and palate is very treatable; however, the kind of
treatment depends on the type and severity of the cleft.

Within the first 2-3 months after birth, surgery is

performed to close the cleft lip

While surgery to repair a cleft lip can be performed soon

after birth, the often preferred age is at approximately 10
weeks of age, following the "rule of 10s" coined by
surgeons Wilhelmmesen and Musgrave in 1969 (the
child is at least 10 weeks of age; weighs at least 10
pounds, and has at least 10g hemoglobin)
HIRSCHSPRUNG DISEASE
 What is Hirschsprung's
disease?
Hirschsprung's (HURSH-sprungz) disease, or HD, is a
disease of the large intestine.
The large intestine is also sometimes called the colon.
The word bowel can refer to the large and small
intestines. Hirschsprung's disease usually occurs in
children. It causes constipation, which means that bowel
movements are difficult. Some children with
Hirschsprung's disease can't have bowel movements at
all. The stool creates a blockage in the intestine.
If Hirschsprung's disease is not treated, stool can fill up
the large intestine. This can cause serious problems like
infection, bursting of the colon, and even death.
Why does Hirschsprung's disease
cause constipation?

Normally, muscles in the intestine push

stool to the anus, where stool leaves the
body. Special nerve cells in the intestine,
called ganglion cells, make the muscles
push. A person with Hirschsprung's
disease does not have these nerve cells in
the last part of the large intestine.
Healthy large intestine: Nerve cells are found
throughout the intestine.
Hirschsprung's disease large intestine: Nerve
cells are missing from the last part of the
intestine
 Sometimes the ganglion cells are missing
from the whole large intestine and even
parts of the small intestine before it. When
the diseased section reaches to or
includes the small intestine, it is called
long-segment disease. When the diseased
section includes only part of the large
intestine, it is called short-segment
disease.
 What causes Hirschsprung's
disease?
Hirschsprung's disease develops before a child
is born. Normally, nerve cells grow in the baby's
intestine soon after the baby begins to grow in
the womb. These nerve cells grow down from
the top of the intestine all the way to the anus.
With Hirschsprung's disease, the nerve cells
stop growing before they reach the end.
No one knows why the nerve cells stop growing.
Some children with Hirschsprung's disease have
other health problems, such as Down's
syndrome and other rare disorders.
 In some cases, Hirschsprung's disease is
hereditary
 What are the symptoms of
Hirschsprung's disease?

Symptoms of Hirschsprung's disease

usually show up in very young children.
But sometimes they don't appear until the
person is a teenager or an adult. The
symptoms are a little different for different
ages.
 Symptoms in Newborns

Newborns with Hirschsprung's disease

don't have their first bowel movement
when they should. These babies may also
throw up a green liquid called bile after
eating and their abdomens may swell.
Discomfort from gas or constipation might
make them fussy. Sometimes, babies with
Hirschsprung's disease develop infections
in their intestines.
Symptoms in Young Children

Most children with Hirschsprung's disease

have always had severe problems with
constipation. Some also have more
diarrhea than usual. Children with
Hirschsprung's disease might also have
anemia, a shortage of red blood cells,
because blood is lost in the stool. Also,
many babies with Hirschsprung's disease
grow and develop more slowly than they
should.
 Symptoms in Teenagers and
Adults

Like younger children, teenagers and

adults with Hirschsprung's disease usually
have had severe constipation all their
lives. They might also have anemia.

Those with anemia look pale and tire

easily.
How does the doctor find out if
Hirschsprung's disease is the
problem?

barium enema x ray

manometry
biopsy
 Barium Enema X Ray

In places where the nerve cells are

missing, the intestine looks too narrow. If a
narrow large intestine shows on the x ray,
the doctor knows Hirschsprung's disease
might be the problem.
 Manometry

The doctor inflates a small balloon inside

the rectum. Normally, the anal muscle will
relax. If it doesn't, Hirschsprung's disease
may be the problem. This test is most
often done in older children and adults.
 Biopsy

This is the most accurate test for

Hirschsprung's disease. The doctor
removes and looks at a tiny piece of the
intestine under a microscope. If the nerve
cells are missing, Hirschsprung's disease
is the problem.
 What is the treatment for
Hirschsprung's disease?

Hirschsprung's disease is treated with

surgery. The surgery is called a pull-
through operation. There are three
common ways to do a pull-through, and
they are called the Swenson, the Soave,
and the Duhamel procedures.
Pull-through Surgery
 Colostomy and Ileostomy
Often, the pull-through can be done right after the
diagnosis. However, children who have been very sick
may first need surgery called an ostomy. This surgery
helps the child get healthy before having the pull-
through. Some doctors do an ostomy in every child
before doing the pull-through.
In an ostomy, the doctor takes out the diseased part of
the intestine. Then the doctor cuts a small hole in the
baby's abdomen. The hole is called a stoma. The doctor
connects the top part of the intestine to the stoma. Stool
leaves the body through the stoma while the bottom part
of the intestine heals. Stool goes into a bag attached to
the skin around the stoma. You will need to empty this
bag several times a day.
Step 1: The doctor takes out most of the
diseased part of the intestine.
Step 2: The doctor attaches the healthy part of the
intestine to the stoma (a hole in the abdomen).
 If the doctor removes the entire large intestine
and connects the small intestine to the stoma,
the surgery is called an ileostomy. If the doctor
leaves part of the large intestine and connects
that to the stoma, the surgery is called a
colostomy.
Later, the doctor will do the pull-through. The
doctor disconnects the intestine from the stoma
and attaches it just above the anus. The stoma
isn't needed any more, so the doctor either sews
it up during surgery or waits about 6 weeks to
make sure that the pull-through worked.
ATRESIA ANI
 Pengertian

Anus imperforata merupakan suatu kelainan

malformasi kongenital di mana tidak lengkapnya
perkembangan embrionik pada bagian anus
atau tertutupnya anus secara abnormal atau
dengan kata lain tidak ada lubang secara tetap
pada daerah anus. Anus imperforata ini dapat
meliputi bagian anus, rektum, atau bagian
diantara keduanya.
 Tanda dan Gejala
Gejala yang menunjukan terjadinya atresia ani atau anus
imperforata terjadi dalam waktu 24-48 jam. Gejala itu
dapat berupa:
Tidak dapat atau mengalami kesulitan mengeluarkan
mekonium (mengeluarkan tinja yang menyerupai pita).
Perut membuncit
Muntah
Tidak bisa buang air besar
Pada pemeriksaan radiologis dengan posisi tegak serta
terbalik dapat dilihat sampai dimana terdapat
penyumbatan.
 Penyebab
Faktor kongenital
Faktor lain tak diketahui

Atresia dapat disebabkan oleh beberapa faktor, antara lain:

1. Putusnya saluran pencernaan dari atas dengan daerah

dubur sehingga bayi lahir tanpa lubang dubur
2. Kegagalan pertumbuhan saat bayi dalam kandungan
berusia 12 minggu/3 bulan
3. Adanya gangguan atau berhentinya perkembangan
embriologik didaerah usus, rektum bagian distal serta
traktus urogenitalis, yang terjadi antara minggu keempat
sampai keenam usia kehamilan.
 Penatalaksanaan
1. Kepada ibu hamil hingga kandungan menginjak
usia tiga bulan untuk berhati-hati terhadapobat-
obatan,makananawetan dan alkohol yang dapat
menyebabkan atresia ani
2. Memeriksa lubang dubur bayi saat baru lahir
karena jiwanya terancam jika sampai tiga hari
tidak diketahui mengidap atresia ani karena hal
ini dapat berdampak feses atau tinja akan
tertimbun hingga mendesak paru-parunya.
3. Pengaturan diet yang baik dan pemberian
laktulosa untuk menghindari konstipasi.
 Penanganan Medis

1. Eksisi membran anal

2. Fistula, yaitu dengan melakukan
kolostomi sementara dan setelah umur 3
bulan dilakukan koreksi sekaligus.
 Manfaat kolostomi

1. Mengatasi obstruksi usus

2. Memungkinkan pembedahan
rekonstruktif untuk dikerjakan dengan
lapangan operasi yang bersih
3. Memberi kesempatan pada ahli bedah
untuk melakukan pemeriksaan lengkap
dalam usaha menentukan letak ujung
rektum yang buntu serta menemukan
kelainan bawaan yang lain.
 Terapi definitif

Teknik terbaru dari operasi atresia ani ini

adalah teknik Postero Sagital Ano Recto
Plasty (PSARP).
Anal abscess
An anal abscess is an abscess (a large
pocket of infection) adjacent to the anus.
 Differential Diagnosis

This condition is often mis-diagnosed initially by the patient as a bad

case of hemorrhoids, since this is almost always the cause of any
sudden anal discomfort.

The presence of the abscess, however, is to be suspected when the

pain quickly worsens over one or two days and the usual
hemorrhoid treatments are ineffective in bringing relief. Furthermore,
any serious abscess will eventually begin to cause signs and
symptoms of general infection, including fever and nighttime chills.
A physician can rule out a hemorrhoid with a simple visual
inspection, and usually appreciate an abscess by touch.
 Cause
Abscesses are caused by a high density infection of (usually)
common bacteria which collect in one place or another for any
variety of reasons. Anal abscesses, without treatment, are likely to
spread and affect other parts of the body, particularly the groin and
rectal lumen. All abscesses can progress to serious generalized
infections requiring lengthy hospitalizations if not treated.
Historically, many rectal abscesses are caused by bacteria common
in the digestive system, such as E. coli. While this still continues
often to be the case, there has recently been an uptick in the
causative organism being staphylococcus, as well as the difficult to
treat community-acquired methicillin-resistant S. aureus. Because of
the increasing appearance of more exotic bacteria in anal
abscesses, microbiological examination will always performed on
the surgical exudate to determine the proper course of any antibiotic
treatment.
 Treatment

Anal abscesses, unfortunately, cannot be treated

by a simple course of antibiotics or other
medications. Even small abscesses will need the
attention of a surgeon immediately. Treatment is
possible in an emergency room under local
anesthesia, but it is highly preferred to be
formally admitted to a hospital and to have the
surgery performed in an operating room under
general anesthesia.
 Complications

In severe or recurrent abscesses, a fistula

may develop, connecting the rectum to the
skin. This requires more intensive surgery.
Furthermore, any untreated abscess may
(and most likely will) continue to expand,
eventually becoming a serious systemic
infection.