Sistem Skoring Keberhasilan Reduksi Hidrostatik pada Pasien Intussusepsi di RSUP Dr.Sardjito Yogyakarta

Dewi Novitasari Arifin, Dr. dr. Akhmad Makhmudi, SpB, SpBA(K).; dr. Andi Dwihantoro SpB SpBA (K)

2023 | Tesis-Spesialis | SP ILMU BEDAH ANAK

Latar Belakang: Intussusepsi adalah proses dimana segmen usus bagian proksimal masuk ke dalam lumen usus bagian distal. Keterlambatan diagnosis sering terjadi dan dapat menyebabkan obstruksi, nekrosis, dan perforasi usus. Salah satu tatalaksana non operatif pada intussusepsi adalah reduksi hidrostatik, sedangkan operasi dilakukan pada kasus yang gagal dengan reduksi. Tujuan penelitian ini adalah untuk mencari sistem skoring yang dapat memprediksi keberhasilan reduksi hidrostatik yang mencakup beberapa faktor prognostik seperti usia, berat badan, muntah, durasi gejala, BAB lendir darah, distensi abdomen, lokasi massa dan pseudo portio sign pada pasien intussusepsi.

Metode: Penelitian ini adalah penelitian kohort retrospektif. Sampel penelitian adalah semua pasien bayi dan anak yang terdiagnosis intussusepsi dan sudah dilakukan reduksi hidrostatik, yang dirawat di RSUP Dr. Sardjito Yogyakarta dari Januari 2017 hingga Desember 2021. Data penelitian berasal dari rekam medik.

Hasil: Jumlah total subjek adalah sebanyak 61 orang. Terdapat 37.7% pasien yang berhasil reduksi hidrostatik sementara 62,3% lainnya gagal. Terdapat hubungan yang bermakna antara keberhasilan reduksi hidrostatik terhadap usia, berat badan, durasi gejala, muntah, BAB lendir darah, distensi abdomen, lokasi massa, dan pseudo portio sign (p < 0>2 (<2>=2), didapatkan nilai sensitivitas 92,1%, spesifisitas 82,6%, nilai duga positif 89,7%, dan nilai duga negatif 86,4%. Nilai AUC didapatkan sebesar 0,907.

Kesimpulan: Durasi gejala >48 jam, BAB lendir darah dan lokasi massa merupakan komponen penyusun sistem skoring keberhasilan reduksi hidrostatik pada pasien intussusepsi di RSUP Dr. Sardjito Yogyakarta.

Background: Intussusception is a process of the proximal intestinal segment that enters the distal intestinal lumen. Delay in diagnosis is common and can lead to bowel obstruction, necrosis, and perforation. One of the non-operative management of intussusception is hydrostatic reduction, whereas surgery is performed in cases that failed with reduction. The purpose of this study was to find a scoring system that can predict the success of hydrostatic reduction, which includes several prognostic factors such as age, weight, vomiting, duration of symptoms, bloody mucus stools, abdominal distension, location of mass and pseudo portio sign in intussusception patients.

Method: This was a retrospective cohort study. The sample was all infants and children diagnosed with intussusception and had been treated with hydrostatic reduction at Dr. Sardjito Hospital, Yogyakarta, from January 2017 to December 2021. The research data source is from medical records.

Results: The total number of subjects was 61 people. There were 37.7% of patients who succeeded in hydrostatic reduction, while 62.3?iled. There was a significant relationship between the success of hydrostatic reduction with age, body weight, duration of symptoms, vomiting, bloody mucus stools, abdominal distension, location of mass, and pseudo portio sign (p<0>=2) showed the sensitivity value of 92.1%, the specificity of 82.6%, the positive predictive value of 89.7%, and the negative predictive value of 86.4%. The AUC value was 0.907.

Conclusion: Duration of symptoms >48 hours, bloody mucus stools and location of the mass were the components of the scoring system for successful hydrostatic reduction in intussusception patients at Dr. Sardjito Yogyakarta Hospital.

Kata Kunci : Intussusepsi, reduksi hidrostatik, sistem skoring, Intussusception, hydrostatic reduction, scoring system