Fistel Vesicovaginalis, Ureterocutaneous, dan Ureterorectalis

7/23/2019 Fistel Vesicovaginalis, Ureterocutaneous, dan Ureterorectalis

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BAGIAN ILMU BEDAH CASE REPORT

FAKULTAS KEDOKTERAN NOVEMBER 2013

UNIVERSITAS HASANUDDIN

Wanita dengan Fistel Vesicovaginalis, Ureterocutaneous,

dan Ureterorectalis

OLEH :

Julie C! G! U"#$%

C1110&20'

PEMBIMBING :

()! M! T*+*,i J$u-$)i

SUPERVISOR:

()! S.$/)i S.$-)i) S! U

BAGIAN ILMU BEDAH

FAKULTAS KEDOKTERAN

UNIVERSITAS HASANUDDIN

MAKASSAR

2013


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HALAMAN PENGESAHAN

$+ #e)$+($$+$+ (i #$,$- i+i "e+.$$/$+ #$-,$:

N$"$ : Julie C! G! U"#$%

NIM : C111 0& 20'

Ju(ul4 : 5$+i$ (e+$+ Fi%el Ve%i6*7$i+$li% U)ee)*6u$+e*u% ($+

U)ee)*)e6$li%

Tel$- "e+.ele%$i/$+ u$% case report($l$" )$+/$ /e$+ie)$$+ /li+i/ $($

#$i$+ Il"u Be($- F$/ul$% Ke(*/e)$+ U+i7e)%i$% H$%$+u((i+!

M$/$%%$) N*7e"#e) 2013

Sue)7i%*) Pe"#i"#i+

()! S.$/i) S.$-)i) S! U ()! M! T*+*,i J$u-$)i


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Laporan Kasus

Wanita dengan Fistel Vesicovaginalis, Ureterocutaneous, dan UreterorectalisJuliet C G Umbas, Tontowi Jauhari, Syakri Syahrir

Sub Bagian Bedah Urologi. Bagian Ilmu Bedah. akultas !edokteran Uni"ersitas #asanuddin

Summary

$eporting case, %emale && years old with "esico"aginalis,

ureterocutaneous, and ureterorectalis %istulae with e'tra"asation urine to genital

organs as the chie% complaint. (atient has been ha"ing this complaint %or )

month. *n anamnesis there are true incontinence symptom such as urine

e'tra"asation to the "agina without %eeling o% urinating and without reali+ing it,

persistantly, and do not change when the patient lying, sitting or standing. There

are also complaint where her %eces is mi'ed with urine when the patient de%ecate.#istory o% histerectomy two months ago, %ollowed by se"ere %lank pain on the le%t

side %or two days post operation and urine coming out %rom the unhealed

operation wound ) month later.

Urographine CTscan is done to conclude le%t hydronephrosis and le%t

hydroureter caused by total obstruction o% the le%t distal ureter. There are relation

between le%t ureter to the rectum and abdominal wall, and bladder to "agina.

-e%t nephrotomy is done to di"erse the urine temporarily and a%ter that

there is no "isible o% le%t ureter %istulae track with the rectum and abdominal

wound that pro"ed by (G e'amination, and healing o% abdominal wound.

RingkasanDil$*)/$+ /$%u% 8i%el 7e%i6*7$i+$li% u)ee)*6u$+e*u% ($+

u)ee)*)e6$li% $($ ,$+i$ u"u) 99 $-u+ (e+$+ /elu-$+ u$"$ /e+6i+

"e)e"#e% "el$lui li$+ /e"$lu$+ .$+ (i$l$"i %e$/ 1 #ul$+! P$($ $+$"+e%i%

(i($$/$+ e$l$ true incontinence #e)u$ u)i+e /elu$) "el$lui li$+ 7$i+$

$+$ )$+%$+$+ "i/%i ($+ $+$ (i%$($)i e)u% "e+e)u% #$i/ ,$/u #e)#$)i+

(u(u/ $$uu+ #e)(i)i! Te)($$ ul$ /elu-$+ i+$ #e)6$"u) u)i+e %$$ #u$+ $i)

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$#(*"e+ .$+ "ul$i "e+e)i+!


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Pendahuluan

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Pemeriksaan Fisis

Status Generalis : S$/i %e($+ ii 6u/u 6*"*%"e+i%

Status Vitalis :T : 120&0 ""H

N : &' /$li"e+i


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P : 20 /$li"e+i

S : 3>?*C

Status Urologis

$egio costo"ertebra /01 et /S1nspeksi : $"$/ ,$)+$ /uli %$"$ (e+$+ %e/i$) alignment

7e)e#)$ #$i/ i##u% i($/ $($ i($/ $"$/ $+($=$+($ i+8l$"$%i

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ballottementi+$l i($/ e)$#$

Perkusi : N.e)i /e*/ i($/ $($

$egio abdomen

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Palpasi : $#(*"e+ %-*u8le "$%%$ u"*) i($/ $($ +.e)i e/$+

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$egio genitalia e'terna

Vulva

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%e/i$)+.$ i($/ $"$/ "$%%$ u"*) e)$%$+ F*le. 6$-ee) 1> $($

OUE i($/ $"$/ "$%%$ u"*) $"$/ /elu$) u)i+e le,$ lu#$+

7$i+$ i($/ $($ ($)$-

Palpasi : N.e)i e/$+ i($/ $($ "$%%$u"*) i($/ $($

Perineum


7/24

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Palpasi : N.e)i e/$+ i($/ $($ "$%%$ u"*) i($/ e)$#$

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= e)$#$ 8*)+i +.e)i e/$+


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Ke*+ Ne$i8 Se(i"e+ eiel %el 10

Ni)i P*%ii8 Se(i"e+ l$i+=l$i+ =


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Pemeriksaan Penun-ang Lainnya

= MSCT $#(*"e+ 2?==2013 :


10/24


11/24

H$%il e"e)i/%$$+ MSCT $#(*"e+ (e+$+ /*+)$% **+$+ $i$l

)e8*)"$ %$i$l ($+ 6*)*+$l (e+$+ -$%il %e#$$i #e)i/u :

= T$"$/ /*+)$% "e+i%i /e(u$ PCS u)ee) ($+ #uli #uli (e+$+

(il$$%i $($ PCS ($+ u)ee) /i)i! Di+(i+ #uli=#uli i)eule) e)u$"$

$($ %i%i /i)i (i%e)$i $"#$)$+ $i) 8lui( le7el (i($l$"+.$! T$"$/

e/%)$7$%$%i /*+)$% ($)i u)ee) /i)i /e )e6u" ($+ #uli=#uli /e 7$i+$

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/*+)$% /e )*+$ e)i*+eu"!

= Gi+$l /$+$+ : u/u)$+ ($+ (e+%i$% ($l$" #$$% +*)"$l! Ti($/ $"$/

(il$$%i PCS! Ti($/ $"$/ (e+%i$% #$uSOL!

= Gi+$l /i)i : u/u)$+ ($l$" #$$% +*)"$ $"$/ (il$$%i PCS! Ti($/

$"$/ (e+%i$% #$uSOL!= U)ee) /$+$+ +*)"$l u)ee) /i)i $"$/ (il$$%i ($+ /i+/i+ $($

13 )*/%i"$l!

= L**=l** u%u% .$+ e)%6$+ ($l$" #$$% +*)"$l!

= T$"$/ *%e*8i $($ CV lu"#$li%


12/24

!indakan Pem#edahan )/'%(')(%*

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= L$*)$+ Oe)$%i:

o P$%ie+ (i#$)i+/$+ ($l$" *%i%i l$e)$l (e6u#iu% /i)i (i #$,$- e+$)u-

$+e%e%i

o Di%i+8e/%i ($+ ()$i+

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o Si%i-/$+ e)i*+eu" /e $)$- "e(i$l %$"$i m. psoas e)$$) (e+$+

el$% #u/$ 8$%6i$ e)*$

o I(e+i8i/$%i u)ee) #e#$%/$+ ($)i $)i+$+ %e/i$) euel

o Su%u)i u)ee) %$"$i /e .elu" i+$l (e+$+ "e"#e#$%/$+ ($)i

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.elu"

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Pera0atan Pasca 1edah

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= R$,$ lu/$ ($+ ()$i+

= K*+)*l )$(i*l*i #e)u$ 8** APG >=11=2013


13/24


14/24

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Fistel Vesicovaginalis, Ureterocutaneous, dan Ureterorectalis

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