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Kepada Yth.: HRD. MAKMUR MANGGALA Jl. Pangeran Antasarin No A Perihal: Lamaran Pekerjaan. Dengan hormat,. Sesuai dengan informasi . Penanganan Obstruksi Duodenum pada Anjing: Laporan Kasus (Treatment of . Treatment of the foreign body induced occlusive ileus in dogs. DEFINISI ILEUS OBSTRUKTIF DIDEFINISIKAN SEBAGAI SUMBATAN BAGI JALAN DISTAL ISI USUS YANG DISEBABKAN OLEH OBSTRUKSI MEKANIK.

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There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications.


A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1 st International Congress of the World Society of Emergency Surgery and 9 th Peritoneum and Surgery Society meeting, in Bologna, July, for developing evidence-based recommendations for diagnosis and management of ASBO.

Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel patients with partial ASBO can be managed safely with NOM and tube decompression either with long or NG should be attempted.

The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT ml both immediately at admission or after an initial attempt of conservative treatment of 48 hours. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged.

WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment. Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management.

In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. A low threshold for open obsgruksi should be maintained.

Peritoneal adhesions should obstruksk prevented. Hyaluronic acid-carboxycellulose ipeus and icodextrin can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery. Any intra-abdominal surgical procedure is a procedure inside the peritoneal organ. Intra-abdominal adhesions are strands or membranes of fibrous tissue that can be attached to the various intraabdominal organs, gluing them strongly together.

More thanpatients are estimated to undergo surgery to treat adhesion-induced small-bowel obstruction in the United States annually. Abdominal adhesions pose a significant health problem with major adverse effects on quality of life, use of health care resources, and ilues costs. The presence of adhesions makes re-operation more difficult, adds an average of 24 minutes to the surgery, increases the risk of iatrogenic bowel injury, and makes future laparoscopic surgery more difficult or even not possible [ 1112 ].

Adhesive small bowel obstruction require appropriate management with a proper diagnostic and therapeutic pathway. Indication and length of Non Operative treatment and appropriate timing for surgery may represent an insidious issue. Delay in surgical treatment may cause a substantial increase of morbidity and mortality.

However repeated laparotomy and adhesiolysis may worsen the process of adhesion formation and their severity. Furthermore the introduction and widespread of laparoscopy has raised the question of selection of appropriate patients with ASBO good candidate for laparoscopic approach. On the other hand, several adjuncts for improving the success rate of NOM and clarifying indications and timing for surgery are currently available, such as hyperosmolar water soluble contrast medium.

No consensus has been reached in diagnosing and managing the patients with ASBO and specific and updated guidelines are lacking. We carried out an extensive review of the English-language literature and found that there was little high-level evidence in this field, and no systematically described practical manual for the field. Most importantly, there are no obstrusi diagnostic criteria and therapeutic management guidelines for ASBO, therefore, we would like to establish standards for these items.


The Bologna Guidelines include evidence-based medicine and reflect the international consensus obtained through earnest discussions among professionals in the field on July,at the Belmeloro Convention Center, Bologna, Italy.

The Guidelines are evidence-based, with the grade of recommendation also based on the evidence. The Guidelines present the diagnostic and therapeutic methods for optimal management and prevention of ASBO.

The practice Guidelines promulgated in this work do not represent a standard of practice. They are suggested plans of care, based on best available evidence and the consensus of experts, but they do not exclude other approaches as being within the standard of practice.

For example, they should not be used to compel adherence to a given method of medical management, which method should be finally determined after taking account of the conditions at the relevant medical institution staff obstrujsi, experience, equipment, etc. However, responsibility for the results of treatment rests with those who are directly engaged therein, and not with the consensus group. In the Consensus Conference on July 2 ndthe expert panel had ileua meetings and a further plenary session.

The aim was to focus and clarify the diagnostic and therapeutic issues of the complex management of ASBO, leading to new clinical guidelines, updated and including a wide range of recommendations, for obstduksi, non operative management, timing for surgery, type of surgery and prevention strategies of peritoneal post-operative adhesions causing small bowel obstruction. Based on the review of the current literature, a panel of worldwide experts were invited to participate in the development of the new guidelines.

All members of the expert panel were asked to define ASBO.

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For each step of diagnosis, treatment conservative and surgical and prevention of ASBO, one expert summarized the current state of the art. From the evidence based presentations and the reported statements as well as from the results of the relevant literature review, a preliminary document with the resume of the Consensus Statements and Recommendations was compiled. Comments from the audience were collected and partly included in the manuscript.

In September the expert panel had further contacts for discussing and finalize the final version of the text of the guidelines recommendations. The final version of the guidelines was approved by all experts in the panel as well as the experts from the audience who played an active role in the discussion during the Consensus Conference.

Each ”chapter” consists of a key statement with a grade of recommendation GoR followed by a commentary to explain the rationale and evidence behind the statement. We have used the Oxford hierarchy for grading clinical studies according to levels of evidence. Literature searches were aimed at finding randomized i. Alternatively, low-level evidence mainly case series and case reports; i.

Studies containing severe methodological flaws were downgraded. For each intervention, we considered the obstrhksi and homogeneity of study results, effect sizes, safety, and economic consequences. Systematic literature searches were conducted on Medline and the Cochrane Library until December obdtruksi There were no restrictions regarding the language of publication. We also paid attention to studies that were referenced in systematic reviews or previous guidelines [ http: All studies have been evaluated for quality according to STARD checklist for the reporting of studies of diagnostic accuracy http: STAndards for the Reporting of Diagnostic accuracy studies.

This checklist is found at: Categories of evidence refer to levels of evidence and grades of recommendations on the homepage of the Centre for Evidence-Based Medicine http: Updated by Jeremy Howick March Users can add ilus minus-sign “-” to obsruksi the level of that fails to provide a conclusive answer because:. Such evidence is inconclusive, and therefore can only generate Grade D recommendations.

Not all systematic reviews with statistically significant heterogeneity need be worrisome, and not all worrisome heterogeneity need be statistically significant. As noted above, studies displaying worrisome heterogeneity should be tagged with a “-” at the end of their designated level. These are algorithms or scoring systems that lead to a prognostic estimation or a diagnostic category. An “Absolute SnNout” is a diagnostic finding whose Sensitivity is so high that a Negative result rules-out the diagnosis.


Poor reference standards are haphazardly applied, but still independent of the test. Use of a non-independent reference standard where the lpp is included in the ‘reference’, or where the ‘testing’ affects the ‘reference’ implies a level 4 study.

Worse-value treatments are as good and more expensive, or worse and the equally or more expensive. An exploratory study collects information and trawls the data e.

Patients with ASBO treated nonsurgically have shorter hospital stay, however they have an higher recurrence rate, shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is the same. Level of Evidence 2b. All obstduksi being evaluated for small bowel obstruction should have plain films Level of Evidence 2b GoR C.

CT-scans should not be routinely ileu in the decision-making process except when clinical history, physical examination, and plain film are not conclusive for small bostruksi obstruction diagnosis Level of Evidence 2b Obsgruksi B.

In patients undergoing initial non operative conservative management, a water-soluble contrast follow-through should be performed in order to rule out complete ASBO and predict the need for surgery Level of Evidence 1b GoR A. Adhesional postoperative small bowel pp is characterized by the presence of abdominal pain, vomiting, distention, and obstipation, in conjunction of confirmatory imaging.

SBO can be classified according to completeness: Complete or high grade vs. Non-adhesional, according to timing: The most important risk factor for adhesive SBO is obtruksi type of surgery and extent of peritoneal damage.

Surgeries of the colon and rectum are associated with a higher risk of adhesion-related problems [ 14 ].


Total colectomy with ileal pouch-anal anastomosis is the procedure with the highest incidence for adhesion-related problems with an overall incidence of SBO of Other high-risk procedures include gynecologic surgeries Other possible risk factors include age younger than 60 years, previous laparotomy within 5 years, peritonitis, multiple laparotomies, emergency surgery, omental resection, and penetrating abdominal trauma, especially gunshot wounds [ 15 – 18 ].

Recurrence occurred sooner and more frequently in patients managed nonoperatively than in patients managed operatively [ 19 ]. With growing numbers of previous episodes of SBO requiring adhesiolysis, the risk for future re-admission for SBO increases, thus nonsurgical management of the initial episode has been advocated as a risk factor for recurrence [ 20 ]. Age younger than 40 years, the presence of matted adhesions, and surgical complications during the surgical management of the first episode as independent risks for recurrence [ 21 ].

There was no significant difference in treatment type or in incidence or type of prior surgery among patients with early and late small bowel obstruction. In a further multicenter prospective study [ 24 ] including patients operated for ASBO and followed up for 41 months, cumulative incidence of overall recurrence was The beneficial effect of intestinal resection might relate to the decrease of the traumatized intestinal serosa area.

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In this way, it may obstru,si hypothesized that adhesive postoperative SBO frequency is linked to the extent of both the parietal peritoneal trauma incision and site and the intestinal serosa. They conclude that the likelihood of reobstruction increases and the time to reobstruction decreases with increasing number of previous episodes of obstruction.

Patients with matted adhesions have a greater recurrence rate than those with band adhesions. These authors failed to find reliable clinical indicators of impending strangulation and the optimum length of a non operative trial for patients with acute ASBO remains controversial.

Other factors influencing the recurrence rate were the method obstruksii treatment of the last previous ASBO episode conservative versus surgical and the number of abdominal operations prior to the initial ASBO operation.