LapKas III - Malformasi Anorektal Farih

8/19/2019 LapKas III - Malformasi Anorektal Farih

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CASE REPORT

MALFORMASI ANOREKTAL

STASE ILMU BEDAH

RSUD CIANJUR

DISUSUN OLEH

Farih N. Mubarok

200 !00"#

P$%bi%bi&' ( )r. H. *i+o,o Sukar)i- S .B

PROGRAM STUDI PENDIDIKAN DOKTER

FAKULTAS KEDOKTERAN DAN KESEHATAN

UNIVERSITAS MUHAMMADIYAH JAKARTA

2011

1


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BAB I

IDENTITAS PASIEN

Nama : An. R

Usia : !"#an

A$ama : Is#am

A#ama% : G$. A%&Ta'(a. RT. 0)*1). K+#. S,#,- Pan an. /ian "

MRS : 10.10.2011

/M : 31144

A//oa&a%&$ i

K$/uha& U,a%a

Da%an$ "n%"- 5+ sia5an ,5+ asi 5+m!"a%an an"s.

Ri1a+a, P$&+aki, S$kara&'

M+n" "% i!" ,s6 ,s i-+%a7"i %i a- !isa 8A8 saa% "sia 2 7a i6 5+ "% ,s -+m!"n$ an

m+m!+sa . Os %i a- ma" m+n+%+- an +(+#. K+m" ian i!a(a -+ !i an an i-+%a7"i ,s

%i a- m+mi#i-i #"!an$ an"s. Ti a- a a #"!an$ #ain i s+-i%a an"s an %i a- -+#"a -,%, an

a%a" #+n i a i a i s+-i%a an"s a%a"5"n $+ni%a#ia. Saa% "sia 7a i ,s m+n a#ani ,5+ asi

9,#,s%,m . S+%+#a7 i%" -+a aan ,s !ai- an ,"%5"% a i 9,#,s%,m #an9a .

Ri1a+a, P$&+aki, Dahu/u

Ri(a a% -+ an$ +mam ;&<

K+san : im"nisasi %i a- s+s"ai "sia

2


3/27

Ri1a+a, Maka&a&

ASI s+ a- "sia 0 sam5ai s+-a an$6 s"s" ?, m"#a ;&


4/27

o P+ -"si : Tim5ani i -+ +m5a% -"a anIn$"ina# : Ti a- %+ a5a% 5+m!+sa an KG8E-s% +mi%as :

o A%as : 7an$a%6 R/T 2 +%i- o 8a(a7 : 7an$a%6 R/T 2 +%i-

G+ni%a#ia : a#am !a%as n, ma#6 7i5,s5a ia ;&


5/27

+m! i,#,$i an"s6 +-%"m6 an % a-%"s " ,$+ni%a#is6 imana s+5%"m " , +-%a# %i a-

m+m!a$i m+m! an -#,a-a s+9a a s+m5" na. 16)6

!. E%brio/o'iUs"s %+ !+n%"- 5a a min$$" -++m5a% ?as+ +m! i, 7in$$a !"#an -+ +nam ?as+

?+%"s. Us"s %+ !+n%"- 5a a a(a# -+7i "5an is+!"% primitive gut 6 an$ %+ i i a%as )

!a$ian ai%" foregut, midgut, an hindgut . Foregut a-an !+ i?+ +nsiasi m+n a i

?a in$6 +s,57a$"s6 $as%+ 6 ", +n"m6 #i@+ 6 5an9 +as6 an a55a a%"s !i#ia is. Midgut

a-an m+n a i "s"s 7a#"s6 s+-"m6 a55+n i-s6 -,#,n as+n +ns6 an "a5+ %i$a

5 ,-sima# -,#,n % ans@+ s"m s+ an$-an hindgut a-an m+n a i s+5+ %i$a is%a# -,#,n

% ans@+ s"m6 -,#,n +s+n +ns6 si$m,i 6 +-%"m6 !a$ian 5 ,-sima# -ana#is ani a i

sis%+m ani an !a$ian a i sis%+m " ,$+ni%a#. Hindgut m+ "5a-an -+#an "%anmidgut

sam5ai m+m! an -#,a-a6 imana m+m! an ini %+ i i a i endoderm -#,a-a an

ectoderm ana# 5i%.1626)

Pa a min$$" -+#ima masa $+s%asi6 -#,a-a +m! i,ni- m+ "5a-an -an%"n$

+n , + ma# an$ !+ asa# a i , sa#hindgut an a##a,%is i @+n% a#. K#,a-a ;Gam!a

1&A< i5isa7-an a i #"a ,#+7 m+m! ana -#,a-a ;5 ,-%, +"m


6/27

3a%bar # . P+ -+m!an$an an"s an +-%"m 5a a min$$" -+ima sam5ai -+&s+5"#"7 masa $+s%asi. A.

Closing Plate ;P ,-%, +"m m+misa7-an -#,a-a a i a+ a7 #"a


7/27

O%,% asa 5+#@is %+ !a$i m+n a i "a !a$ian ai%" !a$ian 5,s%+ i, is+!"%

s+!a$ai ,%,% ia? a$ma%i- an !a$ian an%+ ,m+ ia# is+!"% s+!a$ai -+#,m5,-

5"!,@is9+ a#. O%,% ia? a$ma%i- !+ asa# a i m+m! an ,!%" a%, an Is97i"m sam5ai

-+ s5ina# is97ia i-a -+m" ian !+ #an "% -+ m+ ia# an -+ !a(a7 mas"- -+ a57+

an,-,sa$+a#6 s+ a% an%+ i, !+ #an "% -+ s+ a% 5,s%+ i+n, m+m!+n%"- s"a%" #+m!a an

,%,% +n$an ,%,% -,n% a#a%+ a#. Ra57+ an,-,-si$+a# !+ a#an -+ !a(a7 an -+ +5an

a i 5+ #+-a%an sa9 "m an %"#an$ -,-si$+"s m+n" " ,%,% s?in$%+ in%+ n"s an

puborectal sling complex mas"- -+ 9ana#is ani m+#a#"i m"9,9"%an+"s "n9%i,n.

K+#,m5,- 5"!,@is9+ a# !+ asa# a i !a$ian !+#a-an$ 5"!is !+ a#an %" "n -+ m+ ia#

an -+ !+#a-an$ mas"- -+ @is9+ a 5+#@is an 5+ in+a# !, . Pa a #a-ia-i -+#,m5,-

,%,% ini %+ i i a i 5"!,@a$ina#is an 5"!,5+ in+"s. Di !a$ian 5,s%+ i, -+#,m5,-

,%,% ini mas"- -+ -ana#is ani an 5+ iana# m+m!+n%"- ,%,% 5"!,ana#is 26)

M"s-"#"s #+@a%, ani m+m!+n%"- ia? a$ma 5+#@is s+ %a !a$ian a%as -ana#is

ani s+ an$-an !a$ian asa n a a a#a7 ,%,% an s?in$%+ ani +-s%+ n"s. An%a a ,%,%

#+@a%, ani an s?in$%+ ani in% +n"s is+!"% s+!a$ai m"s9#+ 9,m5#+= a%a" @+ %i9a#

?i! +. S+9a a in9i -ana#is ani %+ i i a i ,%,% is97i,9,9 $+"s6 ,%,% i#i,9,9 $+"s6 ,%,%

5"!,9,9 $+"s6 ,%,% s?i,n$%+ +-s% +n"s s"5+ ?isia#is an 5 ,?"n a. S+ an$-an #a5isan

an$ !+ ?"n$si s+!a$ai s?in$%+ in%+ n"s 5a a in i@i " n, ma# a a#a7 -+%+!a#an#a5isan si -"#+ a i ,%,% in@,#"n%+ "s"s i s+-i%a an, +-%a#.;263645

4


8/27

3a%bar 2 . S% "-%" +-%"m an -ana#is ana#is

P$%bu/uh Darah )a& P$r +ara6a&Kana#is ana#is !+ asa# a i 5 ,-%, + m an$ m+ "5a-an in@a$inasi +-%, + m6

s+ an$-an +-%"m !+ asa# a i +n , + m. Ka +na 5+ !+ aan asa# an"s an +-%"m ini

ma-a 5+ a a7an6 5+ sa a?an6 s+ %a 5+m!"#"7 @+na an #im?+n a !+ !+ a "$a6

+mi-ian 5"#a +5i%+# an$ m+n"%"5in a. R+-%"m i#a5isi ,#+7 m"-,sa $#an "#+ "s"s

s+ an$-an -ana#is ana#is ,#+7 an, + m an$ m+ "5a-an #an "%an +5i%+# !+ #a5is$+5+n$ -"#i% #"a . Da+ a7 !a%as +-%"m an -ana#is ana#is i%an ai ,#+7 5+ "!a7an

+nis +5i%+#. Kana#is ana#is an -"#i% #"a is+-i%a n a -a a a-an 5+ sa a?an s,ma%i-

s+ns, is an 5+-a %+ 7a a5 an$san$an n + i6 i5+ a a7i ,#+7 a %+ i +-%a#is s"5+ i,

an @+na +-%a#is s"5+ i, 6 5+m!"#"7 #im?a%i-n a m+n" " -+ 5+#@is. S+ an$-an

m"-,sa +-%"m m+m5"n ai 5+ sa a?an ,%,n,m an$ %i a- 5+-a %+ 7a a5 an$san$an

n + i6 i5+ a a7i ,#+7 a %+ i +-%a#is in?+ i, 6 an @+na +-%a#is in?+ i, , P+m!"#i7

#im?a%i-n a m+n" " -+ in$"ina#.1626)


9/27

P+ sa a?an 5a asim5a%i- i-+n a#i-an ,#+7 n+ @"s S)&S !a$ian +5an an$

m+m!+ i 5+ 9a!an$an -+ +-%"m6 n+ @"s %+ s+!"% m+#an "%-an an$san$an a i

$an$#ia 5a a pleksus Auerbach . N+ @"s %+ s+!"% !+ %in a- s+!a$ai sa a? m,%, i- 5a a

in in$ "s"s an +-%"m6 m+n$7am!a% -+ a s?in$%+ in%+ n"s an s+ a!"% s+ns, is

5a a is%+nsi +-%a#.1626)

P+ sa a?an sim5a%is !+ asa# a i 9a!an$ -+ "a6 -+%i$a an -++m5a% $an$#ia

#"m!a#is an 5#+-s"s 5 +a, %i-"s. N+ @"s %+ s!"% m+m!+n%"- 5#+-s"s 7i5,$as% i-"s

5a a @+ %+! a #"m!a#is -+#ima6 -+m" ian %" "n m+#a#"i in in$ 5+#@is !a$ian

5,s%+ ,#a%+ a# s+!a$ai n+ @"s 5 +sa- a#is an !+ $a!"n$ +n$an +n$an $an$#i,n

5+#@i- i !a$ian 5,s%+ ,#a%+ a#. N+ @"s %+ s+!"% !+-+ a s+!a$ai 5+n$7am!a% -+ a

in in$ "s"s an sa a? m,%, i- a i ,%,% s?in$%+ in%+ n"s1626)

S+!a$ian !+sa ,%,% #+@a%, %+ "%ama 5a a !a$ian a%as ;-+#,m5,-

is97i,9,99 $+"s< an !a$ian an%+ i, ;%+ mas"- s+ a!"% vertical muscle complex


10/27

s+im!an$an a-an m+n +!a!-an -+%i a-n, ma#an an$ m+m5+n$a "7i masin$&masin$

?"n$si. 16)

Mo,i/i,a Ko/o&

M,%i#i%as -,#,n !+ !+ a +n$an m,%i#i%as "s"s imana $+#,m!an$ 5+ is%a#%i-

i$an%i ,#+7 a n a $+ a-an massa ?+s+s an$ 5 ,5"#si? is+5an an$ -,#,n. M,%i#i%as

-,#,n ia%" ,#+7 a-%i?i%as #is% i-myogenik an$ i5+ an%a ai ,#+7 5+ sa a?an in% i-si-

an 5#+-s"s mi+n%+ i-"s. S+!a#i-n a 7a# ini "$a i an$san$ ,#+7 inn+ @asi +-s% insi-

a n +?#+-s 7"m, a# s+5+ %i $as% ,-,#i- an i#+,-,#i-. M,%i#i%as -,#,n !+ ?"n$si

"n%"- a!s, !si 9ai an an 5+n , ,n$an massa 5a a (a-%" +?+-asi. G+ a-an a i

si$m,i -+ +-%"m i7am!a% ,#+7 !+!+ a5a m+-anism+ an$ i$"na-an ,#+7-,n%in+nsi 16)

Ko&,i&$& i

K,n%in+nsi a a#a7 -+mam5"an "n%"- m+m5+ %a7an-an ?+s+s a#am 7a# ini

san$a% %+ $an%"n$ 5a a -,nsis%+nsi ?+s+s6 %+-anan a#am an"s6 %+-anan +-%"m6 s+ %a

s" "% an, +-%a#. F+s+s an$ 9ai s"#i% i5+ %a7an-an a#am an"s.16)6

K,n%in+nsi ia%" ,#+7 m+-anism+ @,#"n%+ an in@,#"n%+ an$ m+n a$a

7am!a%an s+9a a ana%,miis an ?isi,#,$is a#ann a ?+s+s -+ +-%"m an an"s.

P+n$7am!a% %+ !+sa s+9a a ?isi,#,$i a a#a7 s" "% an%a a an"s an +-%"m an$

i7asi#-an ,#+7 ,%,% #+@a%, ani !a$ian 5"!, +-%a# an%+ i, an s"5+ i, an ,%,% ini

!+ -,n% a-si s+9a a in@,#"n%+ . A an a 5+ !+ aan an%a a %+-anan a an a-%i@i%as

m,%, i- an"s6 +-%"m6 an si$m,i "$a m+n +!a!-an 5 ,$ +si?i%as 5+#+5asan ?+s+s

%+ #am!a%. K,n% a-si s?in$%+ ani +-s%+ n"s s+5+ %i 5a a 5"!, +-%a#is ia-%i@asi s+9a a

in@,#"n%+ +n$an is%+nsi +-%"m an a5a% m+nin$-a%-an s+9a a @,#"n%++ s+#ama 1&

2 m+ni%. 16)

T+-anan is%i a7a% a#am an"s -" an$ #+!i7 2 &100 mmH$6 a#am +-%"m &20

mmH$. A5a!i#a s" "% an%a a an"s an +-%"m #+!i7 a i 0 ma-a ?+s+s a-an s"#i%

i5+ %a7an-an. 16)

D$6$ka i

10


11/27

Pa a !a i !a " #a7i +?+-asi !+ si?a% ,%,n,m %+%a5i +n$an 5+ -+m!an$an6

ma%" i%as +?+-asi a5a% ia%" . P+min a7an ?+s+s a i -,#,n si$m,i -+ +-%"m

-a an$ i9+%"s-an "$a ,#+7 an$san$ ma-anan %+ "%ama 5a a !a i. A5a!i#a +-%"m

%+ isi ?+s+s ma-a a-an i asa-an ,#+7 +-%"m s+7in$$a m+nim!"#-an -+in$inan "n%"-

+?+-asi. R+-%"m m+m5"n ai -+mam5"an an$ -7as "n%"- m+n$+na# an

m+misa7-an !a7an 5a a%6 9ai 6 an $as. 16)

S a a% "n%"- %+ a in a +?+-asi n, ma# a a#a7 5+ sa a?an s+nsi!+# "n%"-

s+nsasi isi +-%"m an 5+ sa a?an s?in$%+ ani "n%"- -,n% a-si an +#a-sasi6 5+ is%a#%i-

-,#,n an +-%"m n, ma#6 an s% "-%" , $an 5an$$"# an$ n, ma#. Si-a5 !a an

(a-%" +?+-asi "$a m+m+$an$ 5+ anan an$ 5+n%in$. D+?+-asi %+ a i a-i!a%

5+ is%a#%i- +-%"m6 +#a-sasi s?in$%+ ani +-s%+ n"s6 an i!an%" m+n$+ an. 16)

3a%bar ! . R+?#+-s 5a a K,#,n an R+-%"m

Dis%+nsi 5a a +-%"m a-an m+nim!"#-an s%im"#asi an$ m+n$inisiasi r$6/$k

)$6$ka i . R+?#+-s %+ s+!"% m+nim!"#-an -,n% a-si #+ma7 5a a +-%"m an +#a-sasi

s?in$%+ ani in%+ na. S%im"#asi 5a asim5a%i- m+n +!a!-an -,n% a-si -"a% 5a a +-%"m

s+7in$$a m+m5"n ai an i# a#am +?#+-s +?+-asi. A-si 5,%+nsia# an$ is+!a!-an

,#+7 is%+nsi +-%"m i!a(a ,#+7 s+ a!"% sa a? a?+ +n -, a s5ina#is 5a a +$i,

11


12/27

sa- "m6 imana s+ a!"% sa a? +?+ +n m+n$inisiasi -,n% a-si 5+ is%a#%i- 5a a -,#,n

!a$ian !a(a7 an +-%"m. R+?#+-s +?+-asi m+n$" an$i a-si 5,%+nsia# -+ s?in$%+ ani

in%+ n"s s+7in$$a %+ a i +#a-sasi. S?in$%+ ani +-s%+ n"s6 an$ %+ s"s"n a%as ,%,%

s-+#+% an a5a% i-+n a#i-an ,#+7 ,%a-6 m+n9+$a7 5+ +$+ a-an ?+s+s -+#"a a i

+-%"m. K+%i-a s?in$%+ ini i +#a-sasi s+9a a @,#"n%++ 6 ma-a ?+s+s a-an -+#"a .

R+?#+-s +?+-asi !+ #an$s"n$ s+#ama !+!+ a5a m+ni% an s+9a a $ a "a# a-an

!+ -" an$. P+ $+ a-an #"as 5a a -,#,n i5+ -i a-an m+n a i 5+n9+%"s %im!"#n a

+?#+-s +?+-asi -+m!a#i.7. Pa,o6i io/o'i

Pa a 5asi+n +n$an an"s im5+ ?, a%a6 +-%"m $a$a# %" "n -+ -,m5#+-s

s?in$%+ +-s%+ na#. Yan$ %+ a i a a#a7 -an%"n$ +-%"m !+ a-7i an !+ i-a%an 5a a

5+#@is6 i a%as a%a" i!a(a7 m"s-"#"s #+@a%, ani. Pa a s+!a$ian !+sa -as"s6 -an%"n$+-%"m !+ 7"!"$an +n$an sis%+m $+ni%," ina ia a%a" +n$an 5+ in+"m m+#+(a%i

?is%"#a6 s+7in$$a +s- i5si ana%,mis an"s im5+ ?, a%a i !a$i m+n a i #+%a- %in$$i

an #+%a- +n a7 %+ $an%"n$ i a+ a7 mana " "n$ +-%"m !+ a-7i 6 a5a-a7 i a%as

a%a" i !a(a7 m"s-"#"s #+@a%, ani. 8+ asa -an sis%+m -#asi?i-asi6 5 ia an$

m+n + i%a an"s in5+ ?, a%a #+%a- %in$$i "m"mn a !+ i-a%an +n$an " +% a 5a s

m+m! an,sa. Pa a 5+ +m5"an6 an"s im5+ ?, a%a #+%a- %in$$i "m"mn a %im!"#

s+!a$ai 5+ sis%+n -#,a-a. Pa a 5 ia an (ani%a6 i-a #+%a-n a +n a7 s+ in$ %+ a i

?is%"#a 5+ in+"m. Pa a 5 ia6 ?is%"#a !+ i-a%an +n$an a57+ m+ ia s- ,%"m a%a" 5+nis.

Pa a 5+ +m5"an6 ?is%"#a a5a% !+ a-7i 5a a @+s%i!"#a @a$ina6 an$ %+ #+%a- i #"a

7im+n6 a%a" 5a a 5+ in+"m.3

12


13/27

3a%bar 4 . D+?+- +m! i,$+n+sis an"s an an, +-%a#. A6 S%+n,sis an"s a-i!a% -+9i#n a 5, %i, an"s 5a a

m+m! an -#,a-a. B6 M+m! an,"s a% +sia a-i!a% a an a closing plate an$ 5+ sis%+n.C 6 An"s an$

%+ %"%"5. 8a an 5+ in+"m %i a- !+ i-a%an +n$ancloacal plate an$ 5+ sis%+n6 s+7in$$a %+ a i ?is%"#a.

D an E6 a$+n+sis an, +-%a# +n$an an %an5a s+5%"m " , +-%a# an$ m+n" "n.F 6 a$+n+sis an"s

+n$an $a$a#n a ?"si i %+n$a7&%+n$a7 #i5a%an s+5%"m " , +-%a#6 m+nin$$a#-an "a ?is%"#a an$

%+ !"-a.3 6 ana# a$+n+sis +n$an ?is%"#a +-%,@a$ina# ;S-an a#a-is JE6 G a S . Em! ,#,$ ?,

S" $+,ns ;2n +


14/27

P$r$% ua& Laki8/akiL+%a- Tin$$i

1. A$+n+sis An, +-%a#a. D+n$an ?is%"#a +-%,@a$ina#

!. Tan5a ?is%"#a2. A% +sia R+-%"m

L+%a- Tin$$i1. A$+n+sis an, +-%a#

a. D+n$an ?is%"#a +-%,5 ,s%a%i- !. Tan5a ?is%"#a

2. A% +sia +-%"mL+%a- In%+ m+ i+%

1. Fis%"#a +-%,@+s%i!"#a 2. Fis%"#a +-%,@a$ina#). A$+n+sis an"s %an5a ?is%"#a

L+%a- In%+ m+ i+%1. Fis%"#a +-%,!"#!a " +% a#2. A$+n+sis an"s %an5a ?is%"#a

L+%a- R+n a71. Fis%"#a an,@+s%i!"#a a

2. Fis%"#a an,-"%an+"sa6!

). S%+n,sis an"s

L+%a- R+n a71. Fis%"#a an,-"%an+"sa

2. S%+n,sis an"s a69

Ma#?, masi K#,a-a ;P+ sis%+n K#,a-a<a M+ "5a-an !+n%"- an$ 5a#in$ s+ in$ i%+m"-an

! T+ mas"- ?is%"#a an$ m"n9"# 5a a 5,s%+ i, #a!ia ma , a6 s+ in$ "$a is+!"% ?," 97+%%+ ?is%"#a+

a%a" @"#@a ?is%"#a+9 S+!+#"mn a is+!"% s+!a$ai 9,@+ + an"s S+!+#"mn a is+!"% "$a ?is%"#a+ +9%,9#,a9a# . Mas"-n a ?is%"#a a5a% 5a a #+%a- %in$$i a%a"

in%+ m+ i+%6 %+ $an%"n$ a i 5an an$n a -ana# -#,a-a.Ta!+# 1. K#asi?i-asi Ma#?, masi An, +-%a# ;S"m!+ : S-an a#a-is JE6 G a S ;+ s


15/27

3a%bar ". K#asi?i-asi ma#?, masi an, +-%a# ;S"m!+ : M, i?i+ ? ,m Ra??+ns5+ $+ JG ;+


16/27

i. D+?+- 5a a La-ia-iFis%"#a 5+ in+"m

Ma#?, masi %i5+ ini m+ "5a-an %i5+ ma#?, masi an$ 5a#in$ sim5+#.

Pa a +?+- ini6 +-%"m %+ !"-a #an$s"n$ i s+!+#a7 an%+ i, sam5ai -+ %+n$a7

s?in$%+ 6 an in in$ an%+ i, +-%"m m+n+m5+# 5a a !a$ian 5,s%+ i, " +% a.O i?isi"m an"s sama s+-a#i %+ %"%"5. Pasi+n 5+n + i%a ma#?, masi ini masi7

!isa m+n$,n% ,# 5+ $+ a-an s?in$%+ n a6 s+7in$$a !+!+ a5a a7#i !+ a7

m+m"%"s-an "n%"- %i a- m+m!+ a7n a. Ji-a m+man$ %i a- i!+ a76 ma-a

an"s 7a "s i i#a%asi s+9a a man"a# an !+ -a#a "n%"- m+m5+ m" a7

+?+-asi6 an , i?isi"m 7a "s i i#a%asi s+9a a !+ -a#a +n$an m+n$$"na-an

a#a% H+$a sam5ai -+ H+$a n,m+ 12 5a a !a i !a " #a7i . In i-asi ,5+ asi

5a a -as"s ini !iasan a -a +na +?+- -,sm+%i-. M+n" "% s5 in$+ 6 -+%i-aia$n,sis s" a7 i%+%a5-an6 ma-a in%+ @+nsi !+ a7 7a "s s+$+ a i#a-"-an.

8+ a7 an$ i#a-"-an %i a- 5+ #" i#a-"-an -,#,s%,mi. 4

3a%bar 7 . Fis%"#a P+ iana# 5a a P ia4

Fis%"#a R+-%," +% a#Fis%"#a %i5+ ini %+ !a$i m+n a i "a -a%+$, i: ;a< ?is%"#a +-%,

" +% a!"#!a ;#+%a- in%+ m+ i+%


17/27

3a%bar . Fis%"#a +-%," +% a !"#!a ;s+!+#a7 -i i< an ?is%"#a +-%,5 ,s%a% ;s+!+#a7 -anan<

Fis%"#a R+-%,@+si-a#Ma#?, masi ini m+ "5a-an %i5+ an$ 5a#in$ s+ in$ i%+m"-an 5a a

ma#?, masi 5 ia. Um"mn a ,s sa- "m 5a a 5+n + i%a ma#?, masi inim+n$a#ami $an$$"an 5+ -+m!an$an. Ma#?, masi %i5+ ini m+ "5a-an sa%"&

sa%"n a ma#?, masi an$ m+m!"%"7-an %in a-an 5+m!+ a7an a i a a7

5,s%+ ,sa$i%a# an a! ,mina# ; +n$an #a5a ,%,mi a%a" #a5a ,s-,5i


18/27

?is%"#a m+n$i a5 o!n "yndome ;DS


19/27

%+ #+!i7 a7"#" a%a" #an$s"n$ i#a-"-an ,5+ asi %an5a -,#,s%,mi.

P+na%a#a-sanaann a %+ $an%"n$ 5a a 5+n$a#aman&5+n$a#aman ,-%+ !+ a7

an$ !+ san$-"%an. K+%i-a !a i #a7i +n$an -,n isi an$ s+7a%6 ma-a

ma#?, masi ini a5a% #an$s"n$ i#a-"-an 5+m!+ a7an -+%i-a !a " #a7i .

Nam"n i-a !a i #a7i 5 +ma%" a%a" m+m5"n ai +?+- #ain6 a-an #+!i7 aman

i-a i#a-"-an -,#,s%,mi %+ #+!i7 a7"#". Nam"n -,#,s%,mi m+m5"n ai isi-,

%in$$i %+ a in a in?+-si6 %+ "%ama 5a a !a i an$ i a(a% ina56 %+ a5a%n a

a in$an 5a "% saa% 5+n"%"5an -,#,s%,mi6 an -+m"n$-inan a an a $an$$"an

-,n% ,# "s"s. 4

3a%bar ## . Fis%"#a +-%,@+s%i!"#a

K#,a-a P+ sis%+nK#,a-a i +?inisi-an s+!a$ai ma#?, masi imana +-%"m6 @a$ina6 an

" +% a !+ $a!"n$ an m+m!+n%"- sa%" sa#" an an$ %+ !"-a 5a a sa%"

, i?isi"m imana " +% a (ani%a %+ !+n%"-. Pan an$ a i sa#" an -#,a-a an$

%+ !+n%"- m+n+n%"-an %+ a5i an 5 ,$n,sis 5+n a-i% ini.Pa a -#,a-a +n$an 5an an$ sa#" an an$ 5+n +- ; ) 9m


20/27

Pa a !a i !a " #a7i an$ m+n + i%a -#,a-a 5+ sis%+n6 ma-a i5+ #"-an

5+m+ i-saan +@a#"asi sis%+m " ,#,$i an USG 5+#@is. 8a i %+ s+!"% %i a-

!,#+7 i !a(a -+ m+ a ,5+ asi %an5a 5+m+ i-saan ini. Ji-a !a i m+n + i%a

7i ,-,#5,s6 ma-a ,-%+ !+ a7 7a "s m+#a-"-an ainas+ isi 7i ,-,#5,s saa%

m+#a-"-an ,5+ asi -,#,s%,mi. Ji-a 7i ,-,#5,s %i a- %+ ainas+ ma-a !+sa

-+m"n$-inan !a i %+ s+!"% m+n$a#ami 7i ,n+? ,sis. J"$a6 i-a ainas+ %i a-

i-"-an s+9a a s+m5" na ma-a a-an %im!"# in?+-si @a$ina ;5 ,-,#5,s


21/27

;-+5a#a i!a(a7< a%a" %i " %+#"n$-"56 +n$an sina 7, iB,n%a# ia a7-an -+ % ,-an%+

ma , . S+#an "%n a i"-" a a- a i " "n$ " a a an$ a a 5a arectal pouch -+ $a is

P/L. 16)

M+man$ 5a a "m"mn a ma#?, masi an, +-%a# a5a% %+ ia$n,sa saa% #a7i 6

nam"n 5a a !+!+ a5a -as"s MAR %+ ia$n,sis 5a a "m" !a i an$ #+!i7 %"a. Kim +%

a#6 m+ +-,m+n asi-an 5a a !a i an$ s" a7 9"-"5 +(asa an ana-&ana- +n$an

$+ a#a VA/TERL ; #ertebral anomalies 7i#an$n a a%a" $a$a# !+ -+m!an$n a

@+ %+! a an 7+mi@+ %+! a+ 6 Anorectal anomalies an"s im5+ ?, a%a 6Cardiac

defects 6 Tracheoesophageal fistula 6 $enal anomalies a$+n+sis $in a# a%a" an,ma#i

$in a# 6 an $adial limb anomalies -+!an a-an !+n%"- is5#asia a i"s


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%i a- #an9a s+7in$$a !iasan a 7a "s s+$+ a i#a-"-an %+%a5i +?ini%i?. 8i#a %i a- a a

?is%+# an 5a a in@+ %,$ am " a a -" an$ 1 9m a i -"#i%6 a5a% s+$+ a i#a-"-an

5+m!+ a7an +?ini%i?. Da#am 7a# ini +@a-"asi %i a- a a6 s+7in$$a 5+ #" i#a-"-an

-,#,s%,mi. 16)

Pemeriksaan khusus pada laki-laki

Yan$ 7a "s i5+ 7a%i-an ia#a7 a an a ?is%+# a%a" -+n, ma#an !+n%"- 5+ in+"m

an a a %i a-n a !"%i m+-,ni"m i " in. Da i -+ "a 7a# %a i 5a a ana- #a-ia-i

a5a% i!"a% -+#,m5,- +n$an a%a" %an5a ?is%+# " in an ?is%+# 5+ in+"m.

K$/ai&a& /$,ak ,i&''i % Ji-a a a ?is%+# " in %am5a- m+-,ni"m -+#"a a i

, i?isi"m +-s%+ n"m " +% a6 m"n$-in %+ a5a% ?is%+# -+ " +% a ma"5"n -+ @+si-a

" ina ia. /a a 5 a-%is "n%"- m+n+n%"-an #+%a- ?is%+# a a#a7 +n$an m+masan$ -a%+%+

" in+. 8i#a -a%+%+ %+ 5asan$ an " in + ni76 !+ a %i ?is%+# %+ #+%a- i " +% a -a +na

?is%+# %+ %"%"5 -a%+%+ . 8i#a +n$an -a%+%+ " in m+n$an "n$ m+-,ni"m !+ a %i ?is%+#

-+ @+si-a " ina ia. 8i#a +@a-"asi ?+s+s %i a- #an9a 6 5+n + i%a m+m+ #"-an -,#,s%,mi

s+$+ a. Pa a a% +sia +-%"m %in a-ann a sama +n$an 5+ +m5"an6 7a "s i!"a%

-,#,s%,mi. Ji-a %i a- a a ?is%+# an " a a #+!i7 a i 1 9m a i -"#i% 5a a in@+ %,$ am6

ma-a 5+ #" s+$+ a i#a-"a-an -,#,s%,mi.

K$/ai&a& /$,ak r$&)ah . Fis%+# 5+ in+"m sama 5a a (ani%a: #"!an$nn a

%+ a5a% an%+ i, a i #+%a- an"s n, ma#. Pa a m+m! an ana# !iasan a %am5a-

!a an$an m+-,ni"m i!a(a7 s+#a5"%. 8i#a +@a-"asi ?+s+s %i a- a a s+!ai-n a

i#a-"-an %+ a5i +?ini%i? s+9+5a% m"n$-in. Pa a s%+n,sis an"s6 sama +n$an 5a a

(ani%a6 %in a-an +?ini%i? 7a "s i#a-"-an. 8i#a %i a- a a ?is%+# an " a a -" an$ 1 9m

a i -"#i% 5a a in@+ %,$ am6 5+ #" "$a s+$+ a i#a-"-an 5+ %,#,n$an !+ a7.

:. P$%$rik aa& P$&u& a&'K+%i-a 5+ %ama-a#i ia$n,sis MAR i%+$a--an6 ma-a 5+m+ i-saan 5+n"n an$

an$ 7a "s i#a-"-an a a#a7 ?,%, ,+n%$+n in@+ %,$ am 2 am s+%+#a7 !a i #a7i .

In@+ %,$ am a a#a7 5+m+ i-saan ,+n%$+n +n$an -+5a#a !a i %+ #+%a- 5a a 5,sisi

!a(a7. Ha# ini !+ %" "an "n%"- m+mas"--an " a a -+ !a$ian 5a#in$ a%as rectal pouch .

#0. Dia'&o i Ba&)i&'

22


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P+n a-i% Hi s975 "n$6 an$ is+!a!-an ,#+7 %i a- %+ 5a%n a s+# $an$#i,n

5a asim5a%is a i 5#+-s"s A"+ !a97 i -,#,n. S+!a$ian !+sa s+$m+n an$

a$an$#i,ni- m+n$+nai +-%"m an !a$ian !a(a7 -,#,n si$m,i an %+ a i 7i5+ % ,?i

s+ %a is%+nsi an$ !+ #+!i7an 5a a -,#,n an$ #+!i7 5 ,-sima#. G+ a#a "%ama 5a a

!a i !a " #a7i !+ "5a m"n%a7 7i a"6 5+n$+#"a an m+-,nii"m an$ %+ #am!a%6 s+ %a

is%+nsi a! ,m+n. G+ a#a %im!"# 5a a "m" 2&) 7a i. 8i#a i#a-"-an 9,#,- "!" 6 %in a

a-an -+#"a m+n +m5 ,%. Dia$n,sis a5a% i%+$a--an s+%+#a7 i#a-"-an 5+m+ i-asaan

!a i"m +n+ma an !i,5s +-%"m ;!i,5s 7i a"


24/27

saa% an$ !+ samaan an$an -,#,s%,mi. Ji-a s+%+#a7 3 !"#an 5 ,s+ " i#a-sana-an

!a i !+ %"m!"7 an !+ -+m!an$ +n$an !ai-6 5asi+n i +-,m+n asi-an "n%"-

5+m!"a%an -#,a-a 5+ sis%+n m+#a#"i )posterior'sagital ano'rekto'vagino'

urethroplasty( ;PSRAVUP


25/27

m+n +!a!-an -+ "sa-an in in$ "s"s an$ i +@+ si!#+ is+ %ai +n$an -+#ainan

7i5,m,%i#i%as in in$ "s"s an$ m+n+%a56 7a# ini a-an m+n +!a!-an -,ns%i5asi i

-+m" ian 7a i. ouble barrel transversocolostomy dextra +n$an %" "an +-,m5 +si

an i@+ si m+mi#i-i -+"n%"n$an an%a a #ain:

1. M+nin$$a#-an s+#" "7 -,#,n -i i !+!as 5a a saa% %in a-an +?ini%? %i a-

m+nim!"#-an -+s"#i%an

2. Ti a- %+ #a#" s"#i% i-+ a-an

). S%,ma is%a# a5a% !+ #a-" s+!a$aimana m"a a 5+#+5asan s+- +% -,#,n is%a#

A. F+s+s -,#,n -anan +#a%i? %i a- !+ !a" is!an in$ -,#,n -i i ,#+7

-a +na 5+m!"s"-an ?+s+s.

8. Dim"n$-in-an i i$asi an 5+n$,s,n$an a i -an%,n$ +-%"m an$

!"n%" 16)

Posterosagital anorectoplasty (PSARP)

M+%, + ini i5+ -+na#-an ,#+7 P+na an + V i+s 5a a %a7"n 1 2. P ,s+ "

ini m+m+! i-an !+!+ a5a -+"n%"n$an s+5+ %i -+m" a7an a#am ,5+ asi ?is%+#

+-%," ina ia ma"5"n +-%,@a$ina# +n$an 9a a m+m!+#a7 ,%,% 5+#@is6 sin$6 an

s?in$%+ . PSARP i!a$i m+n a i %i$a ai%"minimal, limited 6 an full PSARP. 16)

P,sisi 5+n + i%a a a#a7 5 ,n+ +n$an +#+@asi 5a a 5+#@is. D+n$an !an%"an

s%im"#a%, i#a-"-an i +n%i?i-asianal dimple . Insisi im"#ai a i %+n$a7 sa9 "m -+

!a(a7 m+#+(a%i 5"sa% s?in$%+ +-s%+ na sam5ai -+ +5an -" an$ #+!i7 2 9m. Insisi

i5+ a#am +n$an m+m!"-a s"!-"%is6 #+ma-6 parasagital fibre an muscle complex%

T"#an$ coccygeus i!+#a7 s+7in$$a %am5a- in in$ !+#a-an$ +-%"m. R+-%"m

i!+!as-an a i in in$ !+#a-an$ an i-a a a ?is%+# i!+!as-an "$a6 +-%"m

i5isa7-an +n$an @a$ina an$ i!a%asi ,#+7 common !all . D+n$an a7i%an6 +-%"m

i%a i- m+#+(a%i ,%,% #+@a%, 6muscle complex 6 an parasagital fibre -+m" ian

i#a-"-an anoplasty an i a$a a$a %i a- %+$an$.

Un%"- minima# PSARP %i a- i#a-"-an 5+mi%in$an ,%,% #+@a%, ma"5"n

vertical fibre, an$ 5+n%in$ a a#a7 m+misa7-an common !all "n%"- m+misa7-an

+-%"m +n$an @a$ina an i!+#a7 7an a ,%,% s?in$%+ +-s%+ n"s. Un%"-limited

PSARP an$ i!+#a7 a a#a7 ,%,% s?in$%+ +-s%+ n"s6muscle fibre 6 muscle complex,

s+ %a %i a- m+m!+ #a7 %"#an$ 9,99 $+"s. P+n%in$ m+#a-"-an is+-si +-%"m a$a %i a-

m+ "sa- @a$ina. Masin$&masin$ +nis 5 ,s+ " m+m5"n ai in i-asi an$ !+ !+ a.

Minimal PSARP i#a-"-an 5a a ?is%+# 5+ iana#6 ana# s%+n,sis6 ana# m+m! an+6bucket handle 6 an a% +sia ani %an5a ?is%+# an$ a-7i an +-%"m -" an$ a i 1 9m a i -"i%.

2


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*imited PSARP i#a-"-an 5a a a% +sia ani +n$an ?is%+# +-%,@+s%i!"#a . Full PSARP

i#a-"-an 5a a a% +sia ani #+%a- %in$$i6 +n$an $am!a an in@+ %,$ am a-7i +-%"m

#+!i7 a i 1 9m a i -"#i%6 5a a ?is%+# +-%,@a$ina#is6 ?is%+# +-%, " +% a#is6 a% +sia

+-%"m6 an s%+n,sis +-%"m.16)

Da#am a#$, i%m+ an$ a a6 %in a-an -,#,s%,mi 5+ #" i#a-"-an 5a a 5+n + i%a

ma#?, masi an, +-%a# #+%a- %in$$i. K,#,s%,mi a-an m+n$+9i#-an -,#,n !a$ian is%a#

an$ m+m!+sa "$a !+ $"na m+#in "n$i %in a-an ,5+ asi +?ini%i? a i -,n%aminasi

?+s+s 5a a %a7a5 s+#an "%n a. S+%+#a7 %in a-an -,#,s%,mi6 5+n + i%a a5a% m+#a-"-an

,5+ asi +?ini%i? & min$$" -+m" ian. 8i#a %in a-an +?ini%i? i#a-"-an 5a a "sia &

min$$" s+%+#a7 %in a-an -,#,s%,mi6 %+ a5a% !+!+ a5a -+"n%"n$an an%a a #ain:

5+n + i%a %i a- 5+ #" %+ #a#" #ama m+ a(a% s%,ma6 5+ !+ aan an%a "s"s 5 ,-sima# an

is%a# %i a- a a6 sim5#+ ana# i#a%asi6 s+nsasi #,-a# 5a a +-%"m #+!i7 m+nin$-a%.

REFERENSI

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1. P+na6 A. +mperforate Anus and Cloacal Malformation% Pediatric "urgery% rd edition . 8

Sa"n + s. 2000. 5a$+ 4)& 2.2. A%#as N+%%+ 6 7a#. )3 &4

). P+na A6 D+@ i+s PA. Posterior "agital Anorectoplasty- +mportant technicalconsiderations and ne! applications . J P+ ia% S" $ 1 2 14:4 3& 1.

. S-an a#a-is6 J,7n E. "kandalakis "urgical Anatomy . E#s+@i+ . 2003.

. S++#+ 6 S%+57+ns6 Ta%+% Anatomy and Physiology, "ixth .dition . T7+ M9G a(QHi##

/,m5ani+s6 200 .3. 8 "ni9a i F/6 An + s,n DK6 8i##ia TR6 D"nn DL6 H"n%+ JG6 M+%%7+(s J86 P,##,9-

RE: "ch!art/0s Principles of "urgery, 1 th .dition . 200 .4. P" i P.6 H ##(a %7 M. E. Pediatric "urgery . S5 in$+ &V+ #a$ 8+ #in H+i +#!+ $: N+(

Y, -. 200 .

LapKas III - Malformasi Anorektal Farih

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