Pengaruh Enterokolitis Pra Operasi Terhadap Kejadian Hirschsprung-Associated Enterocolitis Pasca Duhamel dan Soave di RSUP Dr. Sardjito Yogyakarta

ISIDORA GALUH PARAHITA, dr. Gunadi, PhD; Dr. dr. Akhmad Makhmudi, Sp.B, Sp.BA; dr. Titik Nuryastuti, M.Si, Ph.D, Sp.MK

2016 | Skripsi | S1 PENDIDIKAN DOKTER

Latar Belakang: Penyakit Hirschsprung (HSCR) terjadi karena tidak terbentuk ganglia parasimpatis di dinding usus. HAEC (Hirschsprung-Associated Enterocolitis) merupakan merupakan risiko morbiditas dan mortalitas terbesar dari HSCR. HAEC dapat terjadi sebelum maupun setelah operasi. Insidensi HAEC pasca operasi di RSUP Dr. Sardjito Yogyakarta pernah diteliti namun belum pernah dilakukan analisis hubungan antara enterokolitis pra operasi dengan kejadian HAEC pasca operasi. Tujuan: Mengetahui pengaruh enterokolitis pra operasi terhadap kejadian HAEC pasca Duhamel dan Soave, serta mengetahui luaran pasien HSCR pasca operasi. Metode: Data dari rekam medik dinilai menggunakan metode Delphi untuk menentukan diagnosis HAEC dan dilanjutkan analisis secara statistik menggunakan SPSS. Hasil: Subyek berjumlah 107 pasien. Insidensi HAEC pasca operasi pada pasien dengan enterokolitis pra operasi sebanyak 55,6% dan pada pasien tanpa enterokolitis pra operasi sebanyak 10,2% (p: 0,003). Mortalitas sebanyak 2,8%. Kelainan penyerta berupa infeksi kulit 5,6%, ISPA 4,7%, pneumonia 3,7%, omphalitis 3,7%, NEC 3,7%, Down syndrome 2%, dan lainnya 11,2%. Komplikasi meliputi sepsis 33,6%, anemia 32,7%, diare 28%, gangguan elek-trolit 15%, kelainan metabolisme plasma protein 10,3%, malnutrisi 8,4% dan kelainan gastrointestinal 7,5%. Kesimpulan: Terdapat pengaruh enterokolitis pra operasi terhadap kejadian HAEC pasca Duhamel dan Soave. Mortalitas pasien HSCR rendah, namun komplikasi cukup banyak dengan beberapa kelainan penyerta.

Background: HD (Hirschsprung Disease) occurs when parasympathetic ganglia on bowel’s wall fail to develop. HAEC (Hirschsprung-Associated Enterocolitis) is a common complication with the highest risk of morbidity and mortality. HAEC can occur pre-operatively or post-operatively. Research of HAEC incidence in RSUP Dr. Sardjito has been done before, but up to now there aren’t any research that analyze the effect of pre-operative enterocolitis to post-operative HAEC incidence yet. Objective: To know the effect of pre-operative enterocolitis to HAEC incidence post Duhamel and Soave, and to know the outcomes of HD. Methods: Data were taken from patient’s medical records and assesed using Delphi method to diagnose HAEC. Then, data were statistically analyzed using SPSS. Result: There were 107 patients. Post-operative HAEC was found in 55,6% patients with pre-operative enterocolitis and 10,2% patients without pre-operative enterocolitis (p: 0,003). Three patients died (2,8%). Complications including sepsis 33,6%, anemia 32,7%, diarrhea 28%, electrolyte imbalance 15%, plasma protein metabolism disorder 10,3%, malnutrition 8,4%, GI disorders 7,5%. Comorbid disorders including skin infection 5,6%, acute respiratory infection 4,7%, NEC 3,7%, pneumonia 3,7%, omphalitis 3,7%, Down syndrome 2%, others 11,2%. Conclusion: There is a significant effect of pre-operative enterocolitis to post-operative HAEC incidence. Patients of HD tend to have a low rate mortality with a high rate of complications an some comorbid disorders.

Kata Kunci : Hirschsprung, Hirschsprung Associated Enterocolitis, enterokolitis pra operasi, Duhamel, Soave