BAGIAN ILMU BEDAH FAKULT FAKULTAS KEDOKTERAN KEDOKTER AN
LAPORAN KASUS
UNIVERSITAS UNIVERS ITAS PATTIMURA
APRIL 2014
RUPTUR URETRA
Oleh: Muhammad Ali Samuda NIM. 2008-83-050
Pembimbi!: Dr. Ahmad Tuahuns, Sp.
DIBA"AKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK BAGIAN ILMU BEDAH RUMAH SAKIT UMUM DAERAH DR# M# HAULUSS$ FAKULTAS AKULTAS KEDOKTERAN KEDOKTE RAN UNIVERSITAS UNIVERS ITAS PA PATTIMURA
AMBON A I !AP"RAN #ASUS
N%m%
: T# L#
U&i%
: 41 '%h(
)ei& Kel%mi
: L%*i+l%*i
Al%m%'
: Be'e! K%,%!
S'%'(& Pe,*%-i%
: Mei*%h
Pe*e,.%%
: Pe*e,.% le/%&
A!%m%
: K,i&'e P,'e&'%
T%!!%l M%&(* RS
: 1 02 14
ANAMNESIS
Dil%*(*% %('%%me&i& /%3% '%!!%l 22 Feb,(%,i 2014
#$luhan U%ama
Pe,3%,%h% 3%,i &%l(,% *emih
Ri&a'a% P$n'a(i% S$(aran)
P%&ie 3%'%! 3e!% ,(.(*% 3%,i RSUD T(leh( Amb 3e!% *el(h% /e,3%,%h% 3%,i &%l(,% *emih &e.%* 1 h%,i SMRS# D%,%h *el(%, mee'e& be,-%,% me,%h &e!%, 'i3%* be,5%m/(, 3e!% (,i# P%&i P%&ie e me! me!%* %*( ( &%%' &%%' i!i i!i BAK BAK 3i,% 3i,%&% &%*% *% 6e, 6e,i# i# BAK BAK *el( *el(%, %, &e3i &e3i*i *i'' 3% 3% be,5%m be,5%m/( /(,, 3%,% 3%,%h# h# Sebel(m6% Sebel(m6% /%&ie me!%l%mi *e5el%*%% &%%' *e,.% &%%' %i* 3i%'%& lem%,i ('(* me!e5%' 3i3i! 3e!% *e'i!!i% 2 me'e, *em(3i% /%&ie .%'(h /(bi&6% 'e,be'(, /e6%!!% *(,&i 7'e,b(%' 3%,i *%6(8 6%! be,%3% 'e/%' 3i b%-%h lem%,i *em(3i% 'e,.%'(h 3%,i *(,&i *el%'%i 3e!% be'(,% me!e%i /i!!%! *%%# Se'el%h .%'(h /%&ie &em/%' me,%&% 'i3%* 3%/%' b%!( &ehi!!% 3ib%'( leh &%l%h &%'( %!!'% *el(%,!% ('(* 3i b%-% *e RSUD T(leh(# S%%' &%m/%i 3i RSUD T(leh( /%&ie .(!% me!el(h 6e,i &%%' me!!e,%*% /%h%# Kem(3i% 3il%*(*% /em%&%!% *%'e'e, %m( *%,e% *el(%, 3%,%h 3%,i *em%l *em%l(% (% /ih%* RSUD T(leh( T(leh( 'i3%* mel% mel%.('*% .('*% 3% mem(' mem('(&*% (&*% ('(* me,(.( me,(.(* *
/%&ie *e RSU H%(l(&&6 ('(* me3%/%' /e%!%% l%.('%# P%&ie 3i ,(.(* 3e!% 3i%!&i& &eme' &eme'%,% %,% S(&/e5' S(&/e5' R(/'(,e R(/'(,e U,e', U,e',%# %# P%&ie P%&ie me!%*( me!%*( &%%' &%%' .%'(h .%'(h *e/%l% *e/%l% 'i3%* 'i3%* 'e,be' 'e,be'(, (, /i!&% /i!&% 3i&%!*%l m('%h 3i&%!*%l#
Ri&a'a% P$n'a(i% Dahulu
+
Ri&a'a% P$n'a(i% #$luar)a
+
PEMERI#SAAN *ISI#
Ke%3%% (m(m : '%m/%* &%*i' &e3%! Ke&%3%,%% : 9m/& me'i&
Tanda +i%al
Te*%% 3%,%h
: 120;0 mmH!
F,e*(ei %3i
: ;4 *%limei'
F,e*(e&i %/%&
: 24 *%limei'
S(h(
: <=>; ?9
STATUS ENERA!IS
#$pala N,m5he/%l De@,mi'%& 7+8
Ramu% Hi'%m l(,(& 'e,&eb%, me,%'% 'i3%* m(3%h 3i5%b('#
Ma%a K.(!'i% %emi& 7++8 &*le,% i*'e,i* 7++8 /(/il b(l%' i&*, 3i%me'e, < mm< mm
,e@le*& 5%h%6% l%!&(! 3% 'i3%* l%!&(! 78
hygiene b%i* Mulu% M(*&% *e,i! 7+8 oral hygiene b%i*
&e,(me 7++8 6e,i 'e*% 7++8 6e,i '%,i* '%,i* 7++8 ',e 7+8 T$lin)a N,m'i% &e*,e' 7++8 &e,(me
/idun) De@,mi'%& 7+8 3ei%&i &e/'(m 7+8 &e*,e' 7+8 6e,i 'e*% &i(& 7+8 ,i,e 7+8
T$n))r(an F%,i! hi/e,emi& 7+8
!$h$r )VP C+2 5mH2O *ele.%, 'i,i3 3% *ele.%, !%'%h bei! 'i3%* 'e,%b% membe&%,
Paru
I&/e*&i : Sime',i& &%%' &'%'i& m%(/( 3i%mi&
P%l/%&i : E*&/%&i 3%3% b%i* vocal fremi fremitus tus *i,i *%%
Pe,*(&i : S, /%3% /%,( *i,i 3% *%%
A(&*(l'%&i : S(%,% %/%& e&i*(le, ,*hi ++ wheezing ++
1an%un)
I&/e*&i : I*'(& *,3i& 'i3%* 'e,lih%'
P%l/%&i : I*'(& *,3i& 'e,%b% /%3% I9S V 1 .%,i me3i%l lie% mi3*l%i*(l% &ii&',%
Pe,*(&i : B%'%& .%'(! 3%l%m b%'%& ,m%l
A(&*(l'%&i : B(6i .%'(! I+II ,e!(le, m(,m(, 7+8 gallop 7+8 gallop 7+8
Adm$n
I&/e*&i : D%'%, .e.%& 7+8
P%l/%&i : T(,!, b%i* defans muscular 7+8 6e,i 'e*% 78 /%3% ,e!i &(/,% /(bi& he/%, 3% lim/% 'i3%* 'e,%b% membe&%,
Pe,*(&i : Tim/%i /%3% &el(,(h %b3me
A(&*(l'%&i : Bi&i! (&(& 78 ,m%l
E(s%r$mi%as : A*,%l h%!%' e3em% ++++
STATUS UR"!"I
Sudu% s% +$r%$ra$
I&/e*&i : m%&&% ++ .e.%&
P%l/%&i : m%&&% ++ 6e,i 'e*% +
Pe,*(&i : 6e,i *e'* ++
R$)i suprapuis
I&/e*&i : m%&&% 7+8 .e.%& 7+8
P%l/%&i : b(li+b(li *&! 6e,i 'e*% 78
Pe,*(&i : ,e3(/
$ni%alia $(s%$rna
Hi/e,emi& 7+8 be!*%* 7+8 6e,i 7+8 &e*,e' 7+8 3%,%h OUE le'%* ,m%l
S*,'(m : be.l% 7+8 '%3% ,%3%! 7+8 'i3%* membe&%,
PEMERI#SAAN PENUN1AN T%!!%l 1+02+2014 /EMAT"!"I Hem!lbi Hem%'*,i' Le(*&i' T,mb&i' E,i',&i'
#imia (lini( SGOT SGPT U,e(m 3%,%h K,e%'ii 3%,%h GDS
, 32 # 1C0 3.40
5 2< 83 .8 10=
!3l ,ib((l ,ib((l .('%(l
Ul Ul m!3l m!3l m!3l
1<2+1< <<+4C C0+100 1C0+440 440+C0
20+40 0=+1C 0+140
RESUME
P%&ie l%*i+l%*i 41 '%h( 3%'%! *e IGD RSUD M# H%(l(&&6 3e!% ,(.(*% 3%,i RSUD T(leh( Sel%'% *el(h% /e,3%,%h% /%3% &%l(,% *emih &e.%* 1 h%,i SMRS# D%,%h *el(%, mee'e& be,-%,% me,%h &e!%, %-%l6% 'i3%* be,5%m/(, 3e!% (,i# N6e,i *e'i*% i!i BAK 3% &%%' BAK *el(%, &e3i*i'+&e3i*i' 3% be,5%m/(, 3%,%h# Sebel(m6% /%&ie me!%l%mi *e5el%*%% *e,.% &%%' me!e5%' 3i3i! 3i%'%& lem%,i 3% .%'(h 'e,be'(, /e6%!!% *(,&i /%3% b%!i% /(bi&6% *em(3i% 'e,.%'(h *el%'%i 3e!% be'(,% me!e%i /i!!%! *%%# Se'el%h .%'(h /%&ie &em/%' me,%&%*% 'i3%* m%m/( m%m/( b%!(# b%!(# P%&ie P%&ie 3ib%-% 3ib%-% *e RSUD RSUD T(leh T(leh( ( &e&%m/ &e&%m/%i %i 3i&%% 3i&%% /%&ie /%&ie me,%&% me,%&%*% *% 6e,i 6e,i &%%' &%%' me! me!!e, !e,%*% %*% /%h% /%h% 3il% 3il%*(* *(*% % /em%& /em%&% %!% !% *%'e' *%'e'e, e, %m( %m( *%,e *%,e% % *el( *el(%, %, 3%,% 3%,%h h /em%&% /em%&%! !% % 3ihe'i*% *em(3i% 3i ,(.(* *e RSUD M# H%(l(&&6# D%,i /eme,i*&%% @i&i* 3i3%/%'*% &'%'(& !ee,%l !ee,%li& i& hem3i hem3i%mi %mi* * &'%bil &'%bil &'%'(& &'%'(& (,l!i (,l!i&& 3i3%/%' 3i3%/%'*% *% .e.%& .e.%& /%3% ,e!i ,e!i /i!!% /i!!%! ! *%% *%% 3% !ei'%l !ei'%li% i% e'e, e'e,%% *el(%, *el(%, 3%,%h# 3%,%h# D%,i D%,i /eme,i /eme,i*&% *&%% % /e(.% /e(.%! ! l%b,% l%b,%', ',i(m i(m 3i3%/%' 3i3%/%'*% *% %emi% %emi% /ei!*%'% (,e(m 3% 5,e%'ii#
DIAN"SIS #ER1A
1# S(&/# R(/'(, (,e',% /%,&i%l %'e,i, e5 ',%(m% 2# S(&/# 9'(&i !i.%l *%% <# S(&/# F,%*'(, /eli&
PENATA!A#SANAAN
1# Ke' Ke', ,l% l%55 <<0 <<0 m! IV 2# T,%m% T,%m%3l 3l 100 100 m! 3%l% 3%l%m m 100 55 55 N%9l N%9l 0# 0# <# T,%& ,%&%m %mi i <C00 <C00 m! 4# Vi'#K i'#K 11 11 %m/ %m/ IV
P!ANIN
1# Si& Si&'!,%@i 2# U,e',!,%m <# F' F' /el /eli& i&
A II DIS#USI
Ke5el Ke5el%*% %*%% % /%3% /%3% /%&ie /%&ie ii ii 3i!l 3i!l! !*% *% *e 3%l% 3%l%m m ',%(m ',%(m%% '(m/ '(m/(l (l %b3m %b3me e 3e&el 3e&el%, %,%& %&ii 6%! 6%! me6eb%b*% %3%6% be'(,% /%3% '(l%! /(bi& &ehi!!% 3%/%' me6eb%b*% ,(/'(,e (,e',%# P%&ie ii 3i 3i5(,i 3i5(,i!%i !%i ,(/'(, ,(/'(, (,e',% (,e',% %'e,i %'e,i, , *%,e% *%,e% 3i 3%/%'*% 3%/%'*% 3%,i 3%,i %%me& %%me&i& i& /eme,i /eme,i*&% *&%% % @i&i* @i&i* 3% /e(.%!# Be,3%&%,*% 'e,i %3%6% ,(/'(, (,e',% me6eb%b*% (,ie 'i3%* 3%/%' be,.%l% mel%l(i &%l(,% (,e',% %*ib%'6% 'e,.%3i i*'ie&i% &%m/%i ,e'e&i (,i# 124=
P,i% 3% -%i'% -%i'% me!%l%mi me!%l%mi ',%(m% ',%*'(& (,i%,i(& (,i%,i(& b%!i% b%-%h 3e!% 5%,% 6%! be,be3%# P%3% -%i'% &e,i! be,h(b(!% 3e!% *%&(& b&'e',i .%,%! *%,e% ',%(m%# Se3%!*% ',%(m% ',%*'(& ',%*'(& (,i%,i(& b%-%h /%3% /,i% 3%/%' me6eb%b*% me6eb%b*% be,b%!%i m%5%m 5e3e,% 6%i'(: 7A8 ,(/'(, b(li i',%/e,i'e%l 7B8 ,(/'(, b(li e*&',%/e,i'e%l 798 ,(/'(, (,e',% /&'e,i, 7D8 ,(/'(, (,e',% /%,& memb,%&% 7E8 ,(/'(, /%,& b(lb&% 3% 7F8 ,(/'(, /eil (,e',%# U,e',% /%,& /,&'%'i*% 'e,li3(!i leh zostate leh zostate+6% +6% &ehi!!% .%,%! ,(/'(,# ,(/'(,# 124
T,%(m T,%(m%% '(m/(l '(m/(l /%3% %b3me %b3me b%-%h b%-%h 3%/%' 3%/%' me6eb%b me6eb%b*% *% ,(/'(, ,(/'(, b(li b(li i',%/ i',%/e,i e,i' 'e%l e%l 7A8# 7A8# F,%*'(, /eli& 3%/%' me6eb%b*% ,(/'(, 7B8 798 3% 7D8 /(*(l% /%3% /e,ie(m 3% (,e',% 3%/%' me6eb%b*% ,(/'(, 7D8 7E8 3% 7F8# P,i% 3%/%' me!%l%mi lebih 3%,i &%'( ,!% 6%! ,(/'(, &e,i! 'e,.%3i *mbi%&i ,(/'(, 7B8 3% 798# L(*% 'emb(& 3%/%' me6eb%b*% 5e3e,% 3i &e'i%/ b%!i% ',%*'(& (,i%,i(&# 124
Gambar. Gambar. Jenis trauma traktus urinarius bagian bawah pada pria.
Di*('i/ 3%,i : P,im%,6 S(,!e,6 Vl#2 Vl#2 T,%(m% : The l-e, (,i%,6 %3 !ei'%l ',%5' : The !ee,%l me'h3 @, % i.(,6 @ 'he l-e, (,i%,6 ',%5'# A%il%ble @,m: h''/:--h''/:---#/,im%,6+&(,!e,6 #/,im%,6+&(,!e,6#,!/&l2h'ml&e5'0<00#h'ml #,!/&l2h'ml&e5'0<00#h'ml C
Se5%,% %%'mi& %%'mi& *em(!*i% *em(!*i% /%&ie me!%l%mi me!%l%mi ,(/'(,e (,e',% %'e,i, %'e,i, 6%! 'e,le'%* 'e,le'%* /%3% 3i&'%l (,e',% /%,& memb,%&%# U,e',% /,i% 3%/%' 3ib%!i me.%3i 2 b%!i%# U,e',% /&'e,i, 'e,m%&(* (,e',% /%,& /,&'%'i*% 6%! mem%.%! 3%,i lehe, *%3(! *emih mel%l(i *ele.%, /,&'%'# Kem(3i% be,!%b(! 3e!% (,e',% /%,& memb,%&% 6%! 'e,le'%* 3i %'%,% /(5%* /,&'%' 3% memb,% /e,ie(m# U,e',% %'e,i, 3im(l%i 3%,i b%!i% 'e,&eb(' 3% memili*i < &e!me# U,e',% /%,& b(lb%, mel%l(i 5,/(& &/!i&(m /,*&im%l 3% i&*i% m(&5(l(& 5%e,&(&+b(lb&/!i&(& ('(* 3%/%' &%m/%i (,e',% /ei&# U,e',% /ei& *em(3i% mel(%& mel%l(i b%!i% 'e,.(mb%i /ei& *e &e!me %*hi, @&&% %i5(l%,i&# F&&% %i5(l%,i& 3iie&'%&i*% leh .%,i!% &/& 3 %,i !l%& /ei&# T,%(m% '(m/(l *e (,e' (,e',% ,% %'e %'e,i ,i, , /%li /%li! ! &e,i &e,i! ! 'e,. 'e,.%3i %3i /%3% /%3% /(*( /(*(l% l% *e &e!m &e!me e b(lb b(lb%, %, &e/e &e/e,' ,'ii 'e,. 'e,.%3 %3ii *e'i *e'i*% *% me!%!*%!i &(%'( b.e* %'%( 3%,i &e,%!% l%!&(! %'%( 'e3%!% *e /e,ie(m##T,%(m% (,e',% %'e,i, '(m/(l *%3%!+*%3%! 3ib&e,%&i .i*% 'e,3%/%' @,%*'(, /ei&# 12
Keb%6%*% 5e3e,% (,e',% %'e,i, 3i&eb%b*% leh ',%(m% '(m/(l *e /e,ie(m straddle 7straddle injury8 injury8 3% b%6%* 6%! m%i@e&'%&i6% 'e,'(3% m(5(l bebe,%/% '%h( *em(3i% &eb%!%i &',i*'(, (,e' (,e',% ,%##
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P%3% /eme,i*&%% /eme,i*&%% /e(.%! /%&ie ii h%6% mel%*(*% /eme,i*&%% /eme,i*&%% l%b,%',i(m# l%b,%',i(m# U,e'h,!,% U,e'h,!,%/h6 /h6 ,e',!,%3e %3%l%h &'(3i /e5i',%% &'%3%, ('(* 3i%!&i& 5e3e,% (,e',%# H%l ii 3il%*(*% 3e!%
me! me!!( !(%*% %*% i.e i.e*& *&ii lemb lemb(' (' 20+< 20+<0 0 mL *' *',% ,%&& *e 3%l% 3%l%m m (,e' (,e',% ,%#Pe #Peme me,i ,i*& *&%% %% 3ib(% 3ib(%'' ('(* ('(* e*&',%%&%&i 6%! 3%/%' 3i*e'%h(i 3e!% %3%6% 'i'i*+'i'i* 3% l*%&i 3%,i !%mb%,% %i, m%'% /%3% (,e',% urethral urethral tear”# tear”#2
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Pel%*&%%% 3e@ii'ie /%3% /%&ie ii %3%l%h 3il%*(*% /em%&%!% *%'e'e, &ili5 3e!% '(.(% 'e,be'(*6 'e,be'(*6%% (,e',% *emb%li 3e!% b%'(% b%'(% *%'e'e, &ili5 &ili5 &eb%!%i .emb%'% .emb%'% &ehi!!% &ehi!!% (,e',% 3%/%' ‟
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